1,145 research outputs found
Implementation of COPCA:A family-centred early intervention programme in infant physiotherapy
No full textThis thesis provides insight in the application and effect of infant physiotherapy in Switzerland. It focuses on the implementation in daily practice of the family-centred early intervention programme “COPing with and CAring for infants with special needs” (COPCA). COPCA has been developed since the beginning of this century by Tineke Dirks (paediatric physiotherapist) and Mijna Hadders-Algra (developmental neurologist) from the University Medical Center Groningen. They developed COPCA because of lacking evidence on the effectiveness of existing physiotherapeutic programmes on motor development of infants at risk of developmental disorders. COPCA differs from typical physiotherapeutic programmes in two ways (1) by including the whole family as active partners; (2) by offering the infant opportunities to learn through self-produced motor behaviour and trial-and error experiences. The thesis shows, that it is possible to implement COPCA successfully in Switzerland, and that Swiss parents of infants with impaired motor development highly appreciate COPCA. They especially valued its home-based setting, the support from the COPCA coach, and the experience being able to promote their infant’s development by integrating stimulating activities in daily routines. The thesis includes a small randomized controlled trial that demonstrated that COPCA was associated with better motor outcomes in infants with motor impairments. The thesis concludes that COPCA enables parents to promote their infants’ motor development in an autonomous way in their real life environment. The promising results of this thesis should be strengthened through studies evaluating the effect of COPCA in a larger group of infants at risk of motor developmental disorders
Quality of general movements: A valuable tool for the assessment of neurological integrity in young infants
No full textDevelopment of brain is fascinating because of the
multitude and complexity of the processes involved
in it. It starts with primary neurulation in the third
and fourth week of gestation. Primary neurulation
refers to formation of the neural tube. This is followed
by prosencephalic development in the second and
third months of gestation. Development of prosencephalon
is considered best in terms of three sequential
events, i.e., prosencephalic formation, prosencephalic
cleavage, and midline prosencephalic development.1
This development is followed by proliferation of the
brain’s total complement of neurons. At a microscopic
level, the first process to occur is neuronal proliferation
and generation of radial glia. This takes place during
the first half of gestation. In addition, cortical neurons
will move from their sites of origin in the ventricular
and subventricular zones to the loci within central
nervous system where they will reside the rest of their
life and start to differentiate. Neuronal differentiation
and organization processes include establishment and
differentiation of sub plate neurons, attainment of
proper alignment, orientation and layering of cortical
neurons, elaboration of dendritic and axonal
ramifications, synapse formation, cell death, selective
elimination of neuronal processes ,synapses,
proliferation and differentiation of glia.1
Organizational events occur in a peak time period from
approximately the fifth month of gestation to several
years after birth. The glia cells take care of axonal
myelination. Myelination occurs especially between
the second trimester of gestation and end in the first
postnatal year. However, it is first completed around
30 years.2
Brain development consists of the creation of
components and the elimination of elements.
Approximately half of the created neurons die
(apoptosis), in particular during mid gestation.
Similarly, axons and synapses are eliminated, the later
especially between 18 months of age and puberty. The
shaping of the nervous system by these regressive
phenomena is guided by neural chemical processes
and neural activity. The neural elements that fit the
environment persist, thus allowing for adaptation of
the brain to its own environment.2
This indicates that not only a substantial part of
brain development occurs before term age, but alsothat throughout childhood the brain is in a continuous
process of remodeling. The presence of continuous
neurobiological changes during childhood has major
clinical consequences such as age specific vulnerability
of the nervous system with age specific signs and
symptoms. Due to the age specific differences, it is
difficult to predict nervous system development
outcome during early infancy. Age specific neurological
assessment is required.2,
Effects of in vitro fertilization and maternal characteristics on perinatal outcomes: a population-based study using siblings
No full textAbstract not availableJorien Seggers, Martina Pontesilli, Anita C. J. Ravelli, Rebecca C. Painter, Mijna Hadders-Algra, Maas Jan Heineman, Sjoerd Repping, Ben Willem J. Mol, Tessa J. Roseboom and Sabine Ensin
Specific characteristics of abnormal general movements are associated with functional outcome at school age
No full textItem does not contain fulltextBACKGROUND: Assessing the quality of general movements (GMs) is a non-invasive tool to identify at early age infants at risk for developmental disorders. AIM: To investigate whether specific characteristics of definitely abnormal GMs are associated with developmental outcome at school age. STUDY DESIGN: Observational cohort study (long-term follow-up). SUBJECTS: Parents of 40 children (median age 8.3 years, 20 girls) participated in this follow-up study. In infancy (median corrected age 10 weeks), the children (median gestational age 30.3 weeks; birth weight 1243 g) had shown definitely abnormal GMs according to Hadders-Algra (2004). Information on specific GM characteristics such as the presence of fidgety movements, degree of complexity and variation, and stiff movements, was available (see Hamer et al. 2011). OUTCOME MEASURES: A standardised parental interview (presence of CP, attendance of school for special education, Vineland Adaptive Behavior Scale to determine functional performance) and questionnaires (Developmental Coordination Disorder Questionnaire [DCD-Q] to evaluate mobility and Child Behavior Checklist to assess behaviour) were used as outcome measures. RESULTS: Six children had cerebral palsy (CP), ten children attended a school for special education, and eight children had behavioural problems. Both the absence of fidgety movements and the presence of stiff movements were associated with CP (p=0.001; p=0.003, respectively). Stiff movements were also related to the need of special education (p=0.009). A lack of movement complexity and variation was associated with behavioural problems (p=0.007). None of the GM characteristics were related to DCD-Q scores. CONCLUSIONS: The evaluation of fidgety movements and movement stiffness may increase the predictive power of definitely abnormal GMs for motor outcome--in particular CP. This study endorses the notion that the quality of GMs reflects the integrity of the infant's brain, assisting prediction of long-term outcome
Prescription of the first prosthesis and later use in children with congenital unilateral upper limb deficiency: A systematic review
No full textBackground: 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
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
Posture and movement in healthy preterm infants in supine position in and outside the nest.
No full textOBJECTIVE: To evaluate whether lying in a nest affects the posture and spontaneous movements of healthy preterm infants.METHOD: 10 healthy preterm infants underwent serial video recording in the supine position, when lying in a nest and outside it, at three ages: 30-33 weeks postmenstrual age (PMA) (early preterm), 34-36 weeks PMA (late preterm) and 37-40 weeks PMA (term). The nest was shell-shaped, made by putting two rolled blankets in a form of an oval. Posture was assessed both before and after general movements by scoring the predominant postural pattern. Movements towards and across the midline, elegant wrist movements, abrupt hand and/or limb movements, rolling to side, and frozen postures of the arms and legs were assessed during four general movements. All data relating to motor and postural items were normalised into frequencies of events per minute because the general movements varied in duration.RESULTS: When lying in the nest, the infants more often displayed a flexed posture with shoulder adduction and elbow, and hip and knee flexion, and the head was frequently in the midline. The nest was also associated with an increase in elegant wrist movements and movements towards and across the midline and a reduction in abrupt movements and frozen postures of the limbs. The nest did not affect the occurrence of asymmetrical tonic neck posture.CONCLUSIONS: A nest promotes a flexed posture of the limbs with adduction of shoulders, facilitates elegant wrist movements and movements towards and across the midline and reduces abrupt movements and frozen postures of the arms and legs
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