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Postural adjustments in sitting position : effect of development, training and brain lesions
No full textThe aim of the present study was to investigate the development of postural adjustments, and how this development could be affected by daily training and early brain lesions. To this end postural adjustments were assessed by means of multiple surface EMGs of neck, trunk and leg muscles and kinematics in various well documented groups of children.The youngest infants aged 5-6 months showed clear evidence that the basic level of postural control was functionally active prior to the development of independent sitting, because their postural adjustments were direction-specific. The latter means that they primarily activated the ventral muscles during backward body sway and the dorsal muscles during forward body sway. Characteristic of the adjustments of the young infants was the large variation in the combination in which the muscles were activated in concert. The variation decreased with increasing age resulting in selection of the most efficient postural response at 9-10 months of age. At this age also a capacity to modulate the direction-specific responses to task-specific conditions, such as initial pelvis position developed. Selection and the development of response modulation were accelerated by daily balance training.Children with severe cerebral palsy (CP) displayed a total or partial loss of direction-specificity, in the children with milder forms of CP direction-specificity was intact. In the latter group of children the adjustments were more often stereotyped than in normally developing children. This was especially true for children with lesions in the periventricular white matter. In addition, children with CP and children born preterm with or without brain lesions showed deficits in the capacity to modulate postural activity with respect to body configuration. Some children lacked this capacity entirely, while others could adapt postural activity in the position which they often adopted during daily life. These data suggest that daily training might improve the reduced modulating capacity in the children with mild to moderate forms of CP.List of scientific papersI. Hadders-Algra M, Brogren E, Forssberg H (1996). Ontogeny of postural adjustments during sitting in infancy: variation, selection and modulation. J Physiol. 493(Pt 1):273-288. https://pubmed.ncbi.nlm.nih.gov/8735712II. Hadders-Algra M, Brogren E, Forssberg H (1996). Training affects the development of postural adjustments in sitting infants. J Physiol. 493(Pt 1):289-298. https://pubmed.ncbi.nlm.nih.gov/8735713III. Brogren E, Hadders-Algra M, Forssberg H (1996). Postural control in children with spastic diplegia: muscle activity during perturbations in sitting. Dev Med Child Neurol. 38(5):379-388. https://pubmed.ncbi.nlm.nih.gov/8698146IV. Brogren E, Hadders-Algra M, Forssberg H (1998). Postural control in sitting children with cerebral palsy. Neurosci Biobehav Rev. 22(4):591-596. https://pubmed.ncbi.nlm.nih.gov/9595574V. Hadders-Algra M, Brogren E, Katz-Salamon M, Forssberg H (1999). Periventricular leucomalacia and preterm birth have different detrimental effects on postural adjustments. Brain. 122(Pt 4):727-740. https://pubmed.ncbi.nlm.nih.gov/10219784VI. Brogren E, Forssberg H, Hadders-Algra M (1999). The influence of tow different sitting positions on postural adjustments in children with spastic diplegia. [Manuscript]</p
Prescription of the first prosthesis and later use in children with congenital unilateral upper limb deficiency: A systematic review
Get PDFBackground: The prosthetic rejection rates in children with an upper limb transversal reduction deficiency are considerable. It is unclear whether the timing of the first prescription of the prosthesis contributes to the rejection rates. Objective: To reveal whether scientific evidence is available in literature to confirm the hypothesis that the first prosthesis of children with an upper limb deficiency should be prescribed before two years of age. We expect lower rejection rates and better functional outcomes in children fitted at young age. Methods: A computerized search was performed in several databases (Medline, Embase, Cinahl, Amed, Psycinfo, PiCarta and the Cochrane database). A combination of the following keywords and their synonyms was used: "prostheses, upper limb, upper extremity, arm and congenital''. Furthermore, references of conference reports, references of most relevant studies, citations of most relevant studies and related articles were checked for relevancy. Results: The search yielded 285 publications, of which four studies met the selection criteria. The methodological quality of the studies was low. All studies showed a trend of lower rejection rates in children who were provided with their first prosthesis at less than two years of age. The pooled odds ratio of two studies showed a higher rejection rate in children who were fitted over two years of age ( pooled OR 3.6, 95% CI 1.6-8.0). No scientific evidence was found concerning the relation between the age at which a prosthesis was prescribed for the first time and functional outcomes. Conclusion: In literature only little evidence was found for a relationship between the fitting of a first prosthesis in children with a congenital upper limb deficiency and rejection rates or functional outcomes. As such, clinical practice of the introduction of a prosthesis is guided by clinical experience rather than by evidence-based medicine
Two distinct forms of minor neurological dysfunction: perspectives emerging from a review of data of the Groningen Perinatal Project
No full textVariability in infant motor behavior: A hallmark of the healthy nervous system
No full textApplication of the concepts of the Neuronal Group Selection Theory (NGST) may shed a new light on motor development. According to NGST, normal motor development is characterized by two phases of variability. Variation is not random, but determined by criteria set by genetic information. Development starts with the phase of primary variability, during which variation in motor behavior is not geared to external conditions. At function-specific ages secondary variability starts, during which motor performance can be adapted to specific situations. In both forms of variability selection on the basis of afferent information plays a significant role. From the NGST point of view, children with pre-or perinatally acquired brain damage suffer from stereotyped motor behavior produced by a limited repertoire of primary (sub)cortical neuronal networks. These children also have problems in selecting the most efficient neuronal activity due to deficits in the processing of sensory information. (C) 2002 Elsevier Science Inc. All rights reserved
General movements: A window for early identification of children at high risk for developmental disorders
No full textDetection of children with a developmental disorder, such as cerebral palsy, at an early age is notoriously difficult. Recently, a new form of neuromotor assessment of young infants was developed, based on the assessment of the quality of general movements (GMs). GMs are movements of the fetus and young infant in which all parts of the body participate. The technique of GM assessment is presented and the features of normal, mildly abnormal, and definitely abnormal GMs discussed. Essential to GM assessment is the Gestalt evaluation of movement complexity and variation. The quality of GMs at 2 to 4 months postterm (so-called fidgety GM age) has been found to have the highest predictive value. The presence of definitely abnormal GMs at this age-that is, GMs devoid of complexity and variation-puts a child at very high risk for cerebral palsy. This implies that definitely abnormal GMs at fidgety age are an indication for early physiotherapeutic intervention
The neuronal group selection theory: promising principles for understanding and treating developmental motor disorders
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