Perinatal stroke causes abnormal trajectory and laterality in reaching during early infancy

The developmental progression of reaching and early signs of upper extremity neglect is common concern for infants at risk for hemiparesis and cerebral palsy. We investigated the emergence of reaching and laterality in infants at risk for hemiplegic cerebral palsy. Eight infants with perinatal stroke (PS) and thirteen infants with typical development (TD) were assessed bimonthly from 2 to 7 months of age for 10 visits per infant. Reaching number and hand-toy contact duration were measured. Infants with PS demonstrated a linear trajectory of reaching behaviors with asymmetrical upper extremity performance. Infants with TD demonstrated a linear and quadratic trajectory of reaching behaviors and symmetrical upper extremity performance over the same age range. These results suggest that infants with PS have delay reaching and early signs of neglect not currently accounted for in clinical practice.     

Sensorimotor recovery in children after traumatic brain injury: analyses of gait, gross motor, and fine motor skills

The recovery of gait, gross motor proficiency, and hand function was examined in 23 children (13 males, 10 females; age 4 years 7 months to 15 years 10 months) with traumatic brain injury (TBI) over five months of in patient rehabilitation. We used gait analysis, the Gross Motor Function Measure, the Developmental Hand Function Test, and the Purdue Pegboard test. Brain injury had been severe (initial Glasgow Coma Scale GCS <8) in 17 children and moderate (GCS 8-10) in six children. Compared with healthy control children of the same age and sex, repeated gait analyses in ambulatory children with brain injury showed significant reductions of velocity, stride length and cadence, and impaired balance. Spatiotemporal gait variables were correlated with Gross Motor Function Measure scores. Hand function tests revealed deficits in fine motor skills, speed, and coordination. Degree of impairment increased with trauma severity. Despite significant improvements, differences in gait velocity, stride length, and hand function of children with brain injuries and controls were still present about 8 months after TBI. Hand motor skills improved less than gait. Young age at injury was not associated with better recovery.     

Fine and gross motor skills differ between healthy-weight and obese children

Within the obesity literature, focus is put on the link between weight status and gross motor skills. However, research on fine motor skills in the obese (OB) childhood population is limited. Therefore, the present study focused on possible weight related differences in gross as well as fine motor skill tasks. Thirty-four OB children (12 ♀ and 22 ♂, aged 7–13 years) were recruited prior to participating in a multidisciplinary treatment program at the Zeepreventorium (De Haan, Belgium). Additionally, a control group of 34 age and gender-matched healthy-weight (HW) children was included in the study. Anthropometric measures were recorded and gross and fine motor skills were assessed using the Bruininks–Oseretsky Test of Motor Proficiency, second edition (BOT-2). Results were analyzed by independent samples t-tests, multivariate analysis of variance, and a chi-squared test. Being OB was detrimental for all subtests evaluating gross motor skill performance (i.e., upper-limb coordination, bilateral coordination, balance, running speed and agility, and strength). Furthermore, OB children performed worse in fine motor precision and a manual dexterity task, when compared to their HW peers. No group differences existed for the fine motor integration task. Our study provides evidence that lower motor competence in OB children is not limited to gross motor skills alone; OB children are also affected by fine motor skill problems. Further investigation is warranted to provide possible explanations for these differences. It is tentatively suggested that OB children experience difficulties with the integration and processing of sensory information. Future research is needed to explore whether this assumption is correct and what the underlying mechanism(s) could be.     

Fine and gross motor skills predict later psychosocial maladaptation and academic achievement

BackgroundDifficulties in fine and gross motor skills are often overlooked as developmental problems, although approximately 6–13% of all school-age children have poor motor coordination. Understanding motor coordination is important from the perspective of school adaptation. This longitudinal cohort study aimed to determine whether fine and gross motor skills in preschool children predict later academic achievement and psychosocial maladaptation.Methods & ProceduresParticipants were 2,501 children from nursery and elementary schools (5–13 years old). The motor skills of preschool children were assessed by their nursery teacher immediately before entering elementary school. The Strengths and Difficulties Questionnaire and a standardized Japanese test were administered annually throughout elementary school.ResultsEarly motor difficulties in preschool children had significant effects on their academic achievement and psychosocial maladaptation up until the sixth grade. Gross motor difficulties in preschool were associated with the later peer problems and worsened emotional symptoms.ConclusionsMotor skills in preschool children are useful as a predictor of later psychosocial maladaptation and academic achievement.     

Cognitive-motor interference during fine and gross motor tasks in children with Developmental Coordination Disorder (DCD)

BackgroundWhile typically developing children produce relatively automatized postural control processes, children with DCD seem to exhibit an automatization deficit. Dual tasks with various cognitive loads seem to be an effective way to assess the automatic deficit hypothesis.AimsThe aims of the study were: (1) to examine the effect of a concurrent cognitive task on fine and gross motor tasks in children with DCD, and (2) to determine whether the effect varied with different difficulty levels of the concurrent task.Methods and proceduresWe examined dual-task performance (Trail-Making-Test, Trail-Walking-Test) in 20 children with DCD and 39 typically developing children. Based on the idea of the Trail-Making-Test, participants walked along a fixed pathway, following a prescribed path, delineated by target markers of (1) increasing sequential numbers, and (2) increasing sequential numbers and letters. The motor and cognitive dual-task effects (DTE) were calculated for each task.ResultsRegardless of the cognitive task, children with DCD performed equally well in fine and gross motor tasks, and were slower in the dual task conditions than under single task-conditions, compared with children without DCD. Increased cognitive task complexity resulted in slow trail walking as well as slower trail tracing. The motor interference for the gross motor tasks was least for the simplest conditions and greatest for the complex conditions and was more pronounced in children with DCD. Cognitive interference was low irrespective of the motor task.Conclusions and implicationsChildren with DCD show a different approach to allocation of cognitive resources, and have difficulties making motor skills automatic. The latter notion is consistent with impaired cerebellar function and the “automatization deficit hypothesis”, suggesting that any deficit in the automatization process will appear if conscious monitoring of the motor skill is made more difficult by integrating another task requiring attentional resources.     

Some comments on the significance and development of midline behavior during infancy

With the waning of the tonic neck reflex beginning with the 8th to 12th week, and disappearing, in most instances, by the 16th week, the infant begins to become bilateral and makes symmetrical movements and engages his hands in the midline usually over the chest while in a supine position. The developmental significance of such behavior is considered--for example, its participation in the emerging sense of self and its role in the consolidation of emerging ego skills. Consideration is given to the possible implications of faulty midline behavior for development, and to whether failure to engage in an optimal amount of midline behavior, in interaction with other factors, can be used to alert observers to possible future developmental disturbances.     

Infants with Down syndrome: Percentage and age for acquisition of gross motor skills

The literature is bereft of information about the age at which infants with Down syndrome (DS) acquire motor skills and the percentage of infants that do so by the age of 12 months. Therefore, it is necessary to identify the difference in age, in relation to typical infants, at which motor skills were acquired and the percentage of infants with DS that acquire them in the first year of life. Infants with DS (N = 20) and typical infants (N = 25), both aged between 3 and 12 months, were evaluated monthly using the AIMS. In the prone position, a difference of up to 3 months was found for the acquisition of the 3rd to 16th skill. There was a difference in the percentage of infants with DS who acquired the 10th to 21st skill (from 71% to 7%). In the supine position, a difference of up to one month was found from the 3rd to 7th skill; however, 100% were able to perform these skills. In the sitting position, a difference of 1–4 months was found from the 1st to 12th skill, ranging from 69% to 29% from the 9th to 12th. In the upright position, the difference was 2–3 months from the 3rd to 8th skill. Only 13% acquired the 8th skill and no other skill was acquired up to the age of 12 months. The more complex the skills the greater the difference in age between typical infants and those with DS and the lower the percentage of DS individuals who performed the skills in the prone, sitting and upright positions. None of the DS infants were able to stand without support.     

The relationship between gross motor skills and academic achievement in children with learning disabilities

The present study compared the gross motor skills of 7- to 12-year-old children with learning disabilities (n = 104) with those of age-matched typically developing children (n = 104) using the Test of Gross Motor Development-2. Additionally, the specific relationships between subsets of gross motor skills and academic performance in reading, spelling, and mathematics were examined in children with learning disabilities. As expected, the children with learning disabilities scored poorer on both the locomotor and object-control subtests than their typically developing peers. Furthermore, in children with learning disabilities a specific relationship was observed between reading and locomotor skills and a trend was found for a relationship between mathematics and object-control skills: the larger children's learning lag, the poorer their motor skill scores. This study stresses the importance of specific interventions facilitating both motor and academic abilities.     

Changes in dendritic morphology and spine density in motor cortex of the adult rat after stroke during infancy

Cognitive and motor deficits are pervasive in children that suffer early brain injury. The aim of this study was to determine the impact that early damage has on dendritic spine density and other aspects of dendritic morphology of neurons in the motor cortex. Also of interest was how changes in dendritic structure evolved across the lifespan. Ischemia was induced in 10‐day‐old Long Evans rats by injection of Rose Bengal dye and a laser positioned over right motor cortex. Animals were sacrificed at two and six months of age, and brains were processed for Golgi‐Cox staining. Animals exposed to early damage exhibited increases in length of basilar dendrites at two months of age, however no differences in spine density were found across groups at this age. At six months of age, injured animals demonstrated an overall decrease in apical and basilar spine density. Our results suggest that the changes in dendritic length and spine density observed after early damage are unable to be maintained as the animal ages. The observation that increases in spine density do not necessarily coincide with increases in dendritic length suggests that the two processes may not be dependent on one another and suggest two independent plasticity processes responding to damage. Synapse 2010. © 2010 Wiley‐Liss, Inc.     

Primary generalized epilepsy during infancy and early childhood

The present study delineates a benign generalized epileptic disorder during infancy and early childhood similar to the well-defined syndrome of primary generalized epilepsy in adolescence. The inclusion criteria for the study required infants under the age of 4 years mainly presenting with generalized nonfebrile seizures, requiring corroboration with generalized epileptic discharges on electroencephalograms (EEGs); an unremarkable pregnancy, labor, and perinatal course; a favorable response to antiepilepsy drugs, preferably monotherapy; and a normal cognitive outcome. The clinical features of seizures, EEG correlates, response to medications, developmental outcome, and family history were analyzed. Twenty-five infants fulfilled the inclusion criteria, presenting at ages 4 to 36 months (mean 17 months) with recurrent generalized clonic seizures, which were commonly short-lived, lasting up to 5 minutes; two infants also had status epilepticus. Fourteen infants (56%) had accompanying febrile seizures, which preceded the nonfebrile seizures in 10 of them. A positive family history of seizures was found in 8 (32%) patients. Analysis of the EEG showed generalized epileptiform discharges in the form of 3 to 4 Hz spike-wave and normal background activity in 21 patients (84%), with a photosensitive response induced in 3 children. A larger group of 18 infants promptly responded to therapy, mainly valproic acid, which was terminated after 2 years, along with EEG normalization and no recurrence of seizures. A smaller group of 7 patients require prolonged therapy that keeps them seizure free; the EEG remains paroxysmal, and the seizures could recur when treatment is discontinued. All patients are presently seizure free within a follow-up period of 1.5 to 14 years. Their cognition is normal, but 12 patients have short attention and concentration spans, impulsiveness, and learning difficulties. As such, the data presented here delineate an idiopathic generalized epileptic disorder during infancy with a benign course, a rapid response to therapy, and preservation of cognitive skills that may be added to the current classification of the epileptic syndromes.     

Early communicative behaviors and their relationship to motor skills in extremely preterm infants

Despite the predictive value of early spontaneous communication for identifying risk for later language concerns, very little research has focused on these behaviors in extremely low-gestational-age infants (ELGA < 28 weeks) or on their relationship with motor development. In this study, communicative behaviors (gestures, vocal utterances and their coordination) were evaluated during mother–infant play interactions in 20 ELGA infants and 20 full-term infants (FT) at 12 months (corrected age for ELGA infants). Relationships between gestures and motor skills, evaluated using the Bayley-III Scales were also examined. ELGA infants, compared with FT infants, showed less advanced communicative, motor, and cognitive skills. Giving and representational gestures were produced at a lower rate by ELGA infants. In addition, pointing gestures and words were produced by a lower percentage of ELGA infants. Significant positive correlations between gestures (pointing and representational gestures) and fine motor skills were found in the ELGA group. We discuss the relevance of examining spontaneous communicative behaviors and motor skills as potential indices of early development that may be useful for clinical assessment and intervention with ELGA infants.     

Development of early motor learning and topical motor skills in a model of cerebellar degeneration

The development of motor learning and topical motor skills has been studied during the first month of life in neurodeficient Lurcher mutant mice derived from C3H strain. The examination of motor functions was conducted using four methods when animals were consecutively placed on: a horizontal wire, a rotating cylinder, a bridge and slanting ladder (on the rotating cylinder and slanting ladder in three different starting positions). A total of 150 animals were used, half being heterozygous mutants (+/Lc), the remaining consisting of their healthy littermates, homozygous wild-type mice (+/+). Some animals of both types were confronted with the tasks in four testing days without practice while the others were trained in all of these methods one time daily at the age of 3, 6, 9, 12, 15, 20, 25 and 30 days. The results of the research are expressed as a percentage of reaching criteria in the trained and untrained mice of both types (+/Lc, +/+), respectively on days 15, 20, 25, and 30. Because of their motor handicap, Lurcher mutants showed significantly worse results than normal mice in almost all of the tests. The most interesting observations of the study were obtained on the rotating cylinder and the slanting ladder tests where mainly untrained mutants were unable to cope promptly with the different starting position and failed. However, in 30-day-old Lurchers the effect of learning was relatively better in some tests when compared with the wild-type of mice. Experiments showed that, in spite of progressive cerebellar degeneration, the ability of motor learning in Lurcher mutants survived to a certain degree. The worsening of results after frequent training in both trained Lurchers and normal mice aged 20 days as compared with untrained ones is discussed within the context of the “overtraining reversal effect” and other possible hypotheses.     

Utility of somatosensory and motor-evoked potentials in reflecting gross and fine motor functions after unilateral cervical spinal cord contusion injury

Fine motor skills are thought to rely on the integrity of ascending sensory pathways in the spinal dorsal column as well as descending motor pathways that have a neocortical origin.However, the neurophysiological processes underlying communication between the somatosensory and motor pathways that regulate fine motor skills during spontaneous recovery after spinal cord contusion injury remain unclear.Here, we established a rat model of cervical hemicontusive injury using C5 laminectomy followed by contusional displacement of 1.2 mm(mild injury) or 2.0 mm(severe injury) to the C5 spinal cord.Electrophysiological recordings were performed on the brachial muscles up to 12 weeks after injury to investigate the mechanisms by which spinal cord pathways participate in motor function.After spinal cord contusion injury, the amplitudes of somatosensory and motor-evoked potentials were reduced, and the latencies were increased.The forelimb open field locomotion test, grooming test, rearing test and Montoya staircase test revealed improvement in functions.With increasing time after injury, the amplitudes of somatosensory and motor-evoked potentials in rats with mild spinal cord injury increased gradually, and the latencies gradually shortened.In comparison, the recovery times of somatosensory and motor-evoked potential amplitudes and latencies were longer, and the recovery of motor function was delayed in rats with severe spinal cord injury.Correlation analysis revealed that somatosensoryevoked potential and motor-evoked potential parameters were correlated with gross and fine motor function in rats with mild spinal cord contusion injury.In contrast, only somatosensory-evoked potential amplitude was correlated with fine motor skills in rats with severe spinal cord injury.Our results show that changes in both somatosensory and motor-evoked potentials can reflect the changes in gross and fine motor functions after mild spinal cord contusion injury, and that the change in somatosensory-evoked potential amplitude can also reflect the change in fine motor function after severe spinal cord contusion injury.This study was approved by the Animal Ethics Committee of Nanfang Hospital, Southern Medical University, China(approval No.NFYY-2017-67) on June 11, 2017.     

Evaluation of gross and fine motor functions in children with hemidecortication: predictors of outcomes and timing of surgery.

The purpose of this study is three-fold: First, to determine the levels of gross and fine motor functions in children before and after hemidecortication, using standardized measurement tools; second, to investigate if predictors of these outcomes can be characterized; and third, to explore if both clinical measures and functional magnetic resonance imaging (MRI) potentially can identify optimal timing of surgery. The Gross Motor Function Measure and the Quality of Upper Extremity Skills Test are shown to be comprehensive, standardized outcome measures of movement performance in affected children. Age at surgery and interval between age at seizure onset and age at surgery could be the most reliable predictors of clinical outcomes. Functional MRI studies are valuable in exploring the potential of the cortical reorganization that sustains residual sensorimotor function. The combination of clinical measures with functional MRI is a promising method of inquiry into developmental and plasticity processes.     

Development of early motor skills and language in children at risk for familial dyslexia

Differences in motor development and the relationship between motor and language development were studied in 88 children with familial risk for dyslexia (43 females, 45 males; at-risk group) and 88 children without familial risk for dyslexia (35 females, 53 females; control group; n=176) during the first two years of life. A structured parental questionnaire was used to assess motor development. Expressive language skills were assessed at the age of 18 months with the Reynell Developmental Language Scales and at 18 and 24 months with the MacArthur Communicative Development Inventories. At group level, the motor development of children in both the at-risk and control groups was similar. However, motor development showed a different pattern in these groups. Cluster analyses revealed three clusters in the control group: 'fast motor development', 'slow fine motor development', and 'slow gross motor development'. In the at-risk group, only two clusters were found: 'slow motor development' and 'fast motor development'. A significant difference (p=0.03) was found between the clusters in the MacArthur Communicative Development Inventories. Children with familial risk for dyslexia and slow motor development had a smaller vocabulary and produced shorter sentences than the all other children. Associations between motor and language difficulties are discussed.     

Severe head injury in early infancy: analysis of causes and possible predictive factors for outcome

Object The aim of this study was to analyse the causes and prognostic factors for outcome in severe traumatic brain injuries (TBI) in early infancy. Materials and methods We present a retrospective study on 16 infants aged less than 12 months observed over the last 20 years in our department for severe brain injury. Infants were evaluated by the Children Coma Scale (CCS). We assessed Glasgow Outcome Scale (GOS) at discharge and at 12 months after discharge. Conclusions The main causes of trauma were domestic accidents followed by car accidents. The highest positive correlation was found between the GOS score at 1 year and the presence of hypoxia and hypotension at admission, the presence of hyperglycaemia at 24 h and the occurrence of major clotting disorders. A significant but weaker correlation was found with the CCS at admission, the occurrence of early post-traumatic seizures and the length of stay in the intensive care unit.