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SENSORIMOTOR DEVELOPMENT IN CEREBRAL-PALSIED INFANTS ASSESSED WITH THE UZGIRIS-HUNT SCALES
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The term diplegia should be enhanced. Part II: contribution to validation of a new rehabilitation oriented classification,
No full textRecent proposals of classification for cerebral palsy (CP), mainly revised for
epidemiological purposes, suggest to abandon the use of the term diplegia.
Conversely, in this paper data are presented to support the proposal to maintain
the distinction between spastic tetraplegia and diplegia, and to subdivide this
latter according to four main clinical patterns of walking observable in these
children. This proposal of classification was validated by testing a group of 467
subjects with CP, of whom 213 with diplegia and 115 with tetraplegia,
consecutively admitted between January 2005 and December 2006 to two national
reference centers for this disability. The results were compared with findings
obtained by other methods of classifying gross and fine motor function and
associated disorders. The subjects with tetraplegia strongly differ from those of
diplegia, both for motor functions and for other disabilities. The four main
walking patterns of spastic diplegia were easily recognizable and observers were
able to assign most of the subjects to one form of the classification.
Significant correlations between walking forms of diplegia and distribution of
Gross Motor Function Classification System (GMFCS) levels were found. Some of the
forms significantly differ also for fine motor and mental disability. These
findings suggest that in clinical practice the category of diplegia not only can
be kept as a separate form of CP, but it may be enhanced, through the
identification of different subcategories of children, divided according to their
walking patterns
Which better predicts later outcome in fullterm infants: quality of general movements or neurological examination?
No full textThe qualitative assessment of general movements (GMs) has been shown to be a better predictor of neurological outcome than the traditional neurological examination in brain-damaged preterm infants. The aim of this study was to compare the results of the two techniques in term infants. Off-line assessment of GMs from videorecordings and neurological examinations were carried out, from birth till about 6 months of postterm age, in a group of 58 term infants, the majority of which were affected by mild to severe hypoxic-ischaemic encephalopathy. The agreement between the two techniques and their predictive power, with respect to the neurological outcome at 2 years, were evaluated for four age groups. The range of agreement between neurological and GM findings was between 78 and 83%. At all ages the results of GM observation correlated highly with the neurological outcome; their sensitivity and specificity with respect to outcome were consistently slightly superior to those of neurological examination. If infants normalize after an initial period of transient abnormalities, GMs normalize earlier than the neurological results
Comparison between observation of spontaneous movements and neurologic examination in preterm infants
No full textObjective: The Prechtl method of qualitative assessment of general movements (GMs) has been shown to be a good predictor of neurologic outcome in fetuses, preterm infants, and term infants. The aim of this study was to compare the results of this new technique with those of traditional neurologic examination and of cranial ultrasonography in preterm infants. Methods: Serial videotape recordings (with off-line assessment of GMs), ultrasound examination of the brain, and neurologic examinations were performed from birth until about 6 months of corrected age,on a group of 66 preterm infants whose gestational age ranged from 26 to 36 weeks (mean 30.7 weeks). The agreement between the two techniques and their predictive power, with respect to the neurologic outcome at 2 years of corrected age, were evaluated for five different age groups from preterm age to 65 weeks of postmenstrual age. Results: Overall agreement of the neurologic and GM findings was 80.3% and strongly age related (lower during the preterm and term periods and higher thereafter), At all ages the results of GM observation correlated highly with neurologic outcome; they showed higher sensitivity and specificity than the neurologic examination. This held true in particular before term age, when poor neurologic responses might be related to transient complications, and at term age, mainly because of infants with normal neurologic examination results but unfavorable outcome, During the preterm period the ultrasound results showed a better specificity and a lower sensitivity to outcome than GM findings. Conclusions: The results of this study indicate that quality assessment of GMs should be added to traditional neurologic assessment, neuroimaging, and other tests of preterm infants for diagnostic and prognostic purposes
Differences and variations in the patterns of early independent walking
No full textThe early development of walking was investigated in 25 normal fullterm and in 25 low-risk preterm infants. All subjects were videorecorded within 3-4 weeks of the beginning of independent walking and again 4 months later. Analysis of the videos was carried out according to a predetermined list of items, with a semiquantitative score for each. The results indicate wide interindividual differences in normal infants in the form of independent walking. Several items seemed to be associated in different ways in different individuals. Age of onset, as long as the corrected age was considered, did not differ between preterm and fullterm infants, neither did their walking patterns. Gait asymmetries were often observed in both groups and they were related with asymmetries observable in prewalking locomotor behaviour. Toe-strike often occurred at the beginning of walking, but not after 4 months; in preterm infants the toe strike pattern correlated significantly with certain motor characteristics observed during the first weeks of life
Posture, spontaneous movements, and behavioural state organisation in infants affected by brain malformations
No full textPosture, quantity of spontaneous movement patterns, quality of general movements (GMs), and behavioural state organisation were studied in nine infants affected by documented brain malformations. A single 1 h video recording of five infants and two or more serial video recordings of another four infants were performed after birth. The graphic representation of single movement patterns (actogram) and of behavioural states of one video recording was performed in eight out of nine infants. The quality of GMs was assessed according to Prechtl ́s method in all video recordings. All nine infants showed a less variable posture than normal newborn infants and an unusual resting posture was detected in seven infants. Poor behavioural state organisation without sleep cycles was common to the nine infants and excessive wakefulness was observed in six infants. As for the quantity of single movement patterns, six infants lacked one or two movement patterns normally present in healthy newborn infants. An abnormal quality of GMs was noted in all nine infants and distinct motor abnormalities were observed in single infants. A monotonous and sometimes stereotyped sequence of different body parts involved in the movement (i.e. poor repertoire GMs) was common to all infants. In the four infants of whom two or more video recordings were available, initial poor repertoire GMs were followed by a further deterioration in movement quality. No relationship was found between the quantity of defective brain tissue, lack of a specific part of the brain, type and severity of GM and posture abnormalities
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