Transcranial photobiomodulation for neurodevelopmental disorders: a narrative review.

BACKGROUND: Neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and Down syndrome (DS) significantly impact social, communicative, and behavioral functioning. Transcranial photobiomodulation (t-PBM) with near-infrared light is a promising non-invasive neurostimulation technique for neuropsychiatric disorders, including NDDs. This narrative review aimed to examine the preclinical and clinical evidence of photobiomodulation (PBM) in treating NDDs. METHODS: A comprehensive search across six databases was conducted, using a combination of MeSH terms and title/abstract keywords: "photobiomodulation", "PBM", "neurodevelopmental disorders", "NDD", and others. Studies applying PBM to diagnosed NDD cases or animal models replicating NDDs were included. Protocols, reviews, studies published in languages other than English, and studies not evaluating clinical or cognitive outcomes were excluded. RESULTS: Nine studies were identified, including one preclinical and eight clinical studies (five on ASD, two on ADHD, and one on DS). The reviewed studies encompassed various t-PBM parameters (wavelengths: 635-905 nm) and targeted primarily frontal cortex areas. t-PBM showed efficacy in improving disruptive behavior, social communication, cognitive rigidity, sleep quality, and attention in ASD; in enhancing attention in ADHD; and in improving motor skills and verbal fluency in DS. Minimal adverse effects were reported. Proposed mechanisms involve enhanced mitochondrial function, modulated oxidative stress, and reduced neuroinflammation. CONCLUSIONS: t-PBM emerges as a promising intervention for NDDs, with potential therapeutic effects across ASD, ADHD, and DS. These findings underscore the need for further research, including larger-scale, randomized sham-controlled clinical trials with comprehensive biomarker analyses, to optimize treatment parameters and understand the underlying mechanisms associated with the effects of t-PBM.

Association of polycyclic aromatic hydrocarbons exposure with child neurodevelopment and adult emotional disorders: A meta-analysis study.

BACKGROUND: Polycyclic aromatic hydrocarbons (PAHs) have been demonstrated to be neurotoxic. OBJECTIVES: To summarize the existing epidemiological studies to quantify the effects of PAHs exposure on child neurodevelopment and adult emotional disorders. DATA SOURCES AND STUDY ELIGIBILITY CRITERIA: We conducted a systematic literature search for studies of child neurodevelopment and adult emotional disorders published in English up to April 2022 in the databases of PubMed, Web of Science and Embase using combinations of MeSH terms and Entry terms, and the articles were filtered out according to data availability. A variety of common PAHs were included in the meta-analysis: 1-hydroxynaphthalene, 2-hydroxynaphthalene, 2-hydroxyfluorene, 3-hydroxyfluorene, 9-hydroxyfluorene, 1-hydroxyphenanthrene, 2-hydroxyphenanthrene, 3-hydroxyphenanthrene, 4-hydroxyphenanthrene, 9-hydroxyphenanthrene, 1-hydroxypyrene and benzoapyrene (BaP). STUDY EVALUATION AND SYNTHESIS METHODS: We extracted the content of each article, summarized its design characteristics and performed quality evaluation. We combined the odds ratio (OR) available in various studies to obtain the risk of PAHs exposure and adaptive, language, social, attention, motor skills and child depression/anxiety in children ≤ 15 years old. In addition, we also conducted a meta-analysis on the relationship between PAHs exposure and the risk of depression in adults. RESULTS: We included a total of 16 epidemiological studies (4 cross-sectional studies and 12 cohort studies). The sample size of all included studies ranged from 110 to 9625. Prenatal exposure to PAHs was found to be associated with increased risk of social behavior (OR = 1.60, 95% CI: 1.00-2.54), attention (OR = 2.99, 95% CI: 1.48-6.02), motor skill problems (OR = 1.91, 95% CI: 1.27-2.86) and any adverse neurodevelopmental outcome in children (OR = 2.10, 95% CI: 1.69-2.62). In addition, we found that PAHs exposure could increase the risk of adult depression, with 2-hydroxyfluorene exposure showing the highest combined OR (OR = 1.48, 95% CI: 1.10-2.00). CONCLUSIONS: The results suggested that PAHs exposure are associated with increased risk of child neurodevelopment and adult depression. The neurotoxic effects of PAHs exposure in human being should be paid more attention. The results suggested that PAHs exposure are associated with increased risk of child neurodevelopment and adult depression. The neurotoxic effects of PAHs exposure in human being should be paid more attention. Steps should be taken to enhance the biomonitoring of PAHs and to reduce the exposure in general population.

Pathophysiological relationships between cognitive deficit in bipolar affective disorder and metabolic syndrome.

INTRODUCTION AND OBJECTIVES: Bipolar disorder (BD) has been related to various cognitive dysfunctions as well as to a high prevalence of metabolic syndrome (MS), which seems to influence the cognitive performance of patients with BD. Therefore, different hypotheses have been generated to try to explain the pathophysiological relationship between cognitive deficit in BD and MS. The objective was to review the current literature regarding the possible pathophysiological explanation of the relationship between BD and MS and its effect on cognitive performance of patients with BD. METHODS: A bibliographic search was carried out using MEDLINE, ClinicalKey, EMBASE, Literatura Latino-Americana y del Caribe en Ciencias de la Salud [Latin American and Caribbean Literature in Health Sciences] (LILACS), APA PsycNet, Scopus and Scielo databases, and the Pan-American Medical Electronic Library; using the following search terms: "bipolar disorder"[MeSH Terms] OR "bipolar disorder"[All Fields] OR "mood disorders"[All Fields] AND "cognitive deficit"[MeSH Terms] OR "cognitive deficit"[All Fields] OR "cognitive dysfunction"[All Fields] OR "cognitive impairment"[All Fields] OR "cognitive decline"[All Fields] AND "metabolic syndrome" [MeSH Terms] OR "metabolic abnormalities"[All Fields] OR "metabolic effects"[All Fields] OR "obesity" [All Fields] OR "abdominal obesity" [All Fields] OR "overweight" [All Fields] OR "diabetes" [All Fields] OR "hypertension" [All Fields] AND "antipsychotics" [MeSH Terms] OR "antipsychotics"[All Fields] AND "antidepressants" [MeSH Terms] OR "antidepressants"[All Fields] AND "mood stabilizers" [MeSH Terms] OR "mood stabilizers"[All Fields]. Filters: free full text, full text, from 2001 to 2022. A total of 80 articles in Spanish and English, of any type of design, were selected. Selection and reading were carried out by all the authors. RESULTS AND CONCLUSIONS: The various pathophysiological hypotheses proposed, inflammatory, endocrine, drug, environmental and social, suggest that a series of changes at the macro and microcellular level are correlated in patients with BD and MS with a negative effect on cognition of patients both globally and in specific domains, mainly executive function, memory, attention, and perceptual motor skills. Research processes should be continued to explore the various hypotheses that support the relationship between BD, MS and cognition.

Which outcomes are key to the pre-intervention assessment profile of a child with developmental coordination disorder? A systematic review and meta-analysis.

BACKGROUND: Purpose of this study was to determine what key aspects of function should be incorporated to make up a pre-intervention assessment profile of a child with Developmental Coordination Disorder (DCD); more specifically, what aspects of functioning are implicated in DCD and what is their relative impact? METHODS: A systematic review and meta-analysis were conducted, for which Pubmed, Web of Science, Scopus and Proquest were searched (last update: April 2023, PROSPERO: CRD42023461619). Case-control studies were included to determine point estimates for performances on field-based tests in different domains of functioning. Risk of bias was assessed, and level of evidence estimated. Random-effect meta-analyses were performed to calculate the pooled standardized mean differences for domains of functioning and subgrouping was done for clinically relevant subdomains. Heterogeneity was determined with I2. RESULTS: 121 papers were included for analyses. Data of 5 923 children with DCD were included (59.8% boys) and 23 619 Typically Developing (TD) children (45.8% boys). The mean (SD) age of the DCD group was 10.3y (1.2) and 9.3y (1.3) for the TD children. Moderate evidence was found for motor performance, executive functions, sensory processing and perceptions, cognitive functions and sports and leisure activities to be affected in children with DCD. CONCLUSION: Differences between the two groups varied per domain of functioning. This emphasizes the diversity present within children with DCD and provides a rationale for explaining the heterogeneity in this patient group. Yet, results highlight the potential involvement of all these domains and call for clinicians to be alert not only to examine motor skill difficulties but also other aspects of function. Results indicate the need to develop an individualized pre-intervention multi-dimensional assessment profile for each child with DCD. It also supports the important role that clinicians play in an interdisciplinary team to tackle the difficulties encountered by children with DCD.

Motor training programs of arm and hand in patients with MS according to different levels of the ICF: a systematic review.

BACKGROUND: The upper extremity plays an important role in daily functioning of patients with Multiple Sclerosis (MS) and strongly influences their quality of life. However, an explicit overview of arm-hand training programs is lacking. The present review aims to investigate the training components and the outcome of motor training programs for arm and hand in MS. METHODS: A computerized systematic literature search in 5 databases (PubMed, CINAHL, EMBASE, PEDro and Cochrane) was performed using the following Mesh terms: Multiple Sclerosis, Rehabilitation, Physical Education and Training, Exercise, Patient-Centered Care, Upper Extremity, Activities of Daily Living, Motor Skills, Motor Activity, Intervention Studies and Clinical Trial. The methodological quality of the selected articles was scored with the Van Tulder Checklist. A descriptive analyses was performed using the PICO principle, including scoring of training components with the calculation of Hedges'g effect sizes. RESULTS: Eleven studies were eligible (mean Van Tulder-score = 10.82(SD2.96)). Most studies reported a specific improvement in arm hand performance at the ICF level that was trained at. The mean number of training components was 5.5(SD2.8) and a significant correlation (r = 0.67; p < 0.05) between the number of training components and effect sizes was found. The components 'client-centered' and 'functional movement' were most frequently used, whereas 'distribution based practice', 'feedback' and 'random practice' were never used. The component 'exercise progression' was only used in studies with single ICF body function training, with the exception of 1 study with activity level training. Studies including the component 'client-centred' demonstrated moderate to high effect sizes. CONCLUSION: Motor training programs (both at the ICF body function and activity level) have shown to improve arm and hand performance in MS in which the value of the training specificity was emphasized. To optimize upper extremity training in MS the component 'client-centred' and 'exercise progression' may be important. Furthermore, given the importance attributed to the components 'distribution based practice', 'feedback' and 'random practice' in previous research in stroke patients, the use of these components in arm hand training should be explored in future research.

Parent mediated intervention programmes for children and adolescents with neurodevelopmental disorders in South Asia: A systematic review.

OBJECTIVE: Parent-mediated programmes have been found to be cost effective for addressing the needs of the children and adolescents with Neurodevelopmental Disorders (NDD) in high-income countries. We explored the impact of parent-mediated intervention programmes in South Asia, where the burden of NDD is high. METHODS: A systematic review was conducted using the following databases; PUBMED, MEDLINE, PsycINFO, Google Scholar and Web of Science. Predefined MeSH terms were used, and articles were included if published prior to January 2020. Two independent researchers screened the articles and reviewed data. OUTCOMES MEASURES: The review included studies that targeted children and adolescents between 1 and 18 years of age diagnosed with any of four specific NDDs that are commonly reported in South Asia; Autism Spectrum Disorder (ASD), Intellectual Disability (ID), Attention Deficit Hyperactivity Disorder (ADHD) and Cerebral Palsy (CP). Studies that reported on parent or child outcomes, parent-child interaction, parent knowledge of NDDs, or child activities of daily living were included for full text review. RESULTS: A total of 1585 research articles were retrieved and 23 studies met inclusion criteria, including 9 Randomized Controlled Trials and 14 pre-post intervention studies. Of these, seventeen studies reported effectiveness, and six studies reported feasibility and acceptability of the parent-mediated interventions. Three studies demonstrated improved parent-child interaction, three studies demonstrated improved child communication initiations, five studies reported improved social and communication skills in children, four studies demonstrated improved parental knowledge about how to teach their children, and four studies reported improved motor and cognitive skills, social skills, language development, learning ability, or academic performance in children. CONCLUSION: This systematic review of 23 studies demonstrated improvements in parent and child skills following parent-mediated intervention in South Asia. Additional evaluations of locally customized parent-mediated programmes are needed to support development of feasible interventions for South Asian countries.

Fidgety movements - tiny in appearance, but huge in impact.

OBJECTIVES: To describe fidgety movements (FMs), i.e., the spontaneous movement pattern that typically occurs at 3-5 months after term age, and discuss its clinical relevance. SOURCES: A comprehensive literature search was performed using the following databases: MEDLINE/PubMed, CINAHL, The Cochrane Library, Science Direct, PsycINFO, and EMBASE. The search strategy included the MeSH terms and search strings ('fidgety movement*') OR [('general movement*') AND ('three month*') OR ('3 month*')], as well as studies published on the General Movements Trust website (www.general-movements-trust.info). SUMMARY OF THE DATA: Virtually all infants develop normally if FMs are present and normal, even if their brain ultrasound findings and/or clinical histories indicate a disposition to later neurological deficits. Conversely, almost all infants who never develop FMs have a high risk for neurological deficits such as cerebral palsy, and for genetic disorders with a late onset. If FMs are normal but concurrent postural patterns are not age-adequate or the overall movement character is monotonous, cognitive and/or language skills at school age will be suboptimal. Abnormal FMs are unspecific and have a low predictive power, but occur exceedingly in infants later diagnosed with autism. CONCLUSIONS: Abnormal, absent, or sporadic FMs indicate an increased risk for later neurological dysfunction, whereas normal FMs are highly predictive of normal development, especially if they co-occur with other smooth and fluent movements. Early recognition of neurological signs facilitates early intervention. It is important to re-assure parents of infants with clinical risk factors that the neurological outcome will be adequate if FMs develop normally.

Systematic review of the relationship between habitual physical activity and motor capacity in children with cerebral palsy.

Habitual physical activity (HPA) has many benefits for general health. Motor capacity in children with cerebral palsy (CP) can impact on their HPA. This study aimed to systematically review the available literature on the relationship between HPA and motor capacity in children with CP aged 3-12 years for all gross motor functional abilities (GMFCS I-V) compared to typically developing children. Five electronic databases (Pubmed, Cochrane, Embase, Cinahl and Web of Science from 1989 to November, 2013) were searched using keywords "children with cerebral palsy", "physical activity", "motor capacity" and "motor function" including their synonyms and MesH terms. Studies were included if they (i) were conducted in children with CP aged between 3 and 12 years, (ii) assessed HPA or time spent sedentary, (iii) assessed motor capacity in order to evaluate the relationship between HPA and motor capacity. All articles retrieved were reviewed by two independent reviewers and discussed until they reached consensus. Study quality of reporting was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. Search results identified 864 articles but after review of the title and abstract only 21 articles warranted closer consideration. Ten articles met the strict inclusion criteria as nine articles did not assess HPA and two were conference abstracts. Study quality assessment (STROBE) found nine articles were good quality (≥ 60%) and one was poor quality (55.9%). Participants were mean age 8.4 (SD=2.1) years (range 2-17 years) and included children at all GMFCS levels (3 studies), while seven studies only recruited GMFCS level I-III. HPA measurements were either subjective (Activity Scale for Kids, Dutch Questionnaire of Participation in physical activity and assessment of participation in physical education at school and regular physical activity in leisure time) or objective (StepWatch(®) and ActiGraph(®)7164). Nine studies found that motor capacity was directly associated with HPA, HPA in children with CP with high functional level (GMFCS I) was higher than those with lower functional levels (GMFCS III-V); while one study reported no relationship between HPA and GMFCS level (HPA was measured by questionnaire, a potential limitation). Further studies are required to further elucidate HPA levels (active, sedentary behavior) according to objective motor capacity measures, age and gender to inform healthy lifestyle behavior (active/sedentary) in children with CP.

Fidgety movements – tiny in appearance, but huge in impact / Movimentos irregulares - pequenos na aparência, porém enormes no impacto

Abstract Objectives: To describe fidgety movements (FMs), i.e., the spontaneous movement pattern that typically occurs at 3–5 months after term age, and discuss its clinical relevance. Sources: A comprehensive literature search was performed using the following databases: MEDLINE/PubMed, CINAHL, The Cochrane Library, Science Direct, PsycINFO, and EMBASE. The search strategy included the MeSH terms and search strings (‘fidgety movement*’) OR [(‘general movement*’) AND (‘three month*’) OR (‘3 month*’)], as well as studies published on the General Movements Trust website (www.general-movements-trust.info). Summary of the data: Virtually all infants develop normally if FMs are present and normal, even if their brain ultrasound findings and/or clinical histories indicate a disposition to later neurological deficits. Conversely, almost all infants who never develop FMs have a high risk for neurological deficits such as cerebral palsy, and for genetic disorders with a late onset. If FMs are normal but concurrent postural patterns are not age-adequate or the overall movement character is monotonous, cognitive and/or language skills at school age will be suboptimal. Abnormal FMs are unspecific and have a low predictive power, but occur exceedingly in infants later diagnosed with autism. Conclusions: Abnormal, absent, or sporadic FMs indicate an increased risk for later neurological dysfunction, whereas normal FMs are highly predictive of normal development, especially if they co-occur with other smooth and fluent movements. Early recognition of neurological signs facilitates early intervention. It is important to re-assure parents of infants with clinical risk factors that the neurological outcome will be adequate if FMs develop normally.

Resumo Objetivos: Descrever os movimentos irregulares (FMs), ou seja, o padrão de movimentos espontâneos que normalmente ocorrem entre três e cinco meses após o nascimento e discutir sua relevância clínica. Fontes: Uma pesquisa abrangente na literatura foi feita nas seguintes bases de dados: Medline/PubMed, Cinahl, The Cochrane Library, Science Direct, PsycINFO e Embase. A estratégia de busca incluiu os termos e cadeias de pesquisa do MeSH [(“fidgety movement*”) OU [(“general movement*”) E (“three month*”) OU (“3 month*”)], bem como estudos publicados no website da General Movements Trust (www.general-movements-trust.info). Resumo dos dados: Praticamente todos os neonatos se desenvolveram normalmente se os FMs estiveram presentes e foram normais, mesmo se seus resultados do ultrassom do cérebro e/ou históricos clínicos indicassem tendência a déficits neurológicos posteriores. Por outro lado, quase todos os neonatos que nunca desenvolveram FMs apresentaram maior risco de déficits neurológicos, como paralisia cerebral, e doenças genéticas de início tardio. Caso os FMs fossem normais, porém simultâneos a padrões posturais não adequados para a idade, ou o caráter geral dos movimentos fosse monótono, as capacidades cognitivas e/ou de linguagem na idade escolar seriam abaixo do ideal. Os FMs anormais não são específicos e têm baixo poder preditivo, porém ocorrem em grande parte em neonatos posteriormente diagnosticados com autismo. Conclusões: FMs anormais, ausentes ou esporádicos indicam um risco maior de disfunções neurológicas posteriores, ao passo que FMs normais são altamente preditivos de desenvolvimento normal, principalmente se forem simultâneos a outros movimentos suaves e fluentes. O reconhecimento precoce de sinais neurológicos facilita a intervenção antecipada. É importante garantir aos pais de neonatos com fatores de risco clínicos que o resultado neurológico será adequado se os FMs se desenvolverem normalmente.