STRETCH REFLEXES OF THE NORMAL INFANT

Tendon-jerk reflexes were tested in normal, fullterm infants aged one to four days. EMGs were recorded from gastrocnemius-soleus and tibialis anterior muscles. Reflex-like EMGs were evoked when tapping sites which should not excite the muscles from which that activity is recorded--this included the simultaneous activation of antagonistic muscles by a tendon tap. The possible mechanisms which could produce these results are discussed, as are the possible relationships between the proposed pathways and the reciprocally excitatory paths in cerebral palsy.     

SEQUELAE OF GROWTH FAILURE IN APPROPRIATE FOR GESTATIONAL AGE, VERY LOW-BIRTHWEIGHT INFANTS

The pattern of growth of 235 very low-birthweight children, whose weights were appropriate for gestational age, was characterised by a significant decline in weight, length and head circumference from birth to discharge from hospital, followed by partial recovery in all three measures of growth by two years corrected age. 29 per cent of the children were below the 10th percentile for weight at two years, and this group had a significantly higher incidence of major disabilities, poorer muscular development, more hypotonia and lowered performance on the psychomotor index of the Bayley Scales of Infant Development than their heavier peers. These children's mothers more often perceived them as actively disliking close physical contact, and they were reported by their mothers to have had more infections, minor surgery and chronic otitis media. Taken together, the suboptimal weight-gain, delayed gross motor development and increased maternal perceptions of 'sickliness' and lack of 'cuddliness' in these children are reminiscent of non-organic failure to thrive.     

DEVELOPMENTAL ASPECTS OF FOCAL EPILEPSIES OF CHILDHOOD TREATED BY NEUROSURGERY

Data on 50 patients treated surgically for intractable focal epilepsy were analysed. There were 10 hemispherectomies, 32 temporal lobectomies and eight operations to other areas of the brain. The median age at operation was 14 years. 29 patients were found to have mesial temporal sclerosis or sclerotic hemispheres and 17 had alien tissue and one sclerosis with heterotopia. No lesion was found in three cases. The nature of the first seizure was found to relate significantly to pathology. 30 patients had suffered an early convulsion. Between the convulsive insult and the onset of focal epilepsy there was a silent interval, the duration of which was biased by sex and side of lesion. The remaining 20 patients, of whom a highly significant number had alien tissue, had not had an early convulsion before the onset of focal epilepsy. The importance of accurate clinical histories is stressed. Clinical considerations alone predicted the pathology and laterality of the lesion in more than half the series. Regular EEG recordings and repeat scanning were found to be important investigations. Major disorders of behaviour had occurred in 44 patients. As adults, the series were free of severe psychiatric symptoms, but many required years of careful rehabilitation. 31 children had been excluded from normal schools before operation. Postoperatively, many patients continued their education in normal schools. Some required basic remedial teaching, others successfully undertook higher education and training. 49 patients benefited over-all from neurosurgical treatment. 34 had no more habitual epilepsy at all. Full global gains often took at least five years to achieve.     

SPELLING PERFORMANCE OF CHILDREN WITH DEVELOPMENTAL VERBAL DYSPRAXIA

The ability of four children with developmental verbal dyspraxia to imitate, spell, read and copy regular single-syllable words was investigated. The children were found to have more difficulty in spelling and reading these words than a group of children with normal speech who were matched for reading age. It is suggested that 'dyspraxic' children are subject to a phonetic spelling deficit which arises because of a difficulty in segmenting words at a speech-sound level.     

ASSOCIATED MOVEMENTS AS A MEASURE OF DEVELOPMENTAL AGE

Fifty normal kindergarten and 50 first-grade children were examined three times at six-month intervals for synkineses to stress gaits and mirror movements to finger lifting, finger spreading, and timed motor maneuvers. Motor signs in the age-sensitive range showed substantial individual differences between children of the same chronological age. The frequency of associated movements changed reliably in the expected direction over a 12-month period, and within each domain of neuromotor function the individual motor signs conformed to a stable sequence of developmental stages. It is concluded that age-appropriate motor signs for associated movements are a reliable measure of developmental age, in contrast to chronological age, among elementary-school children.