Development of postural adjustments during reaching in infants with CP

The development of postural adjustments during reaching movements was longitudinally studied in seven infants with cerebral palsy (CP) between 4 and 18 months of age. Five infants developed spastic hemiplegia, one spastic tetraplegia, and one spastic tetraplegia with athetosis. Each assessment consisted of a simultaneous recording of video data and surface EMGs of arm, neck, trunk, and leg muscles during reaching in various lying and sitting positions. The basic organization of postural adjustments of the children developing spastic CP was intact. Their main problem was a deficient capacity to modulate the postural adjustments to task-specific constraints - a deficit which was attributed to a combination of an impaired motor coordination and deficits in sensory integration. The child with spastic-dyskinetic CP showed distinct abnormalities in the basic organization of postural adjustments.     

An evaluation of selected brain constituents as putative excitatory neurotransmitters

Searching for the endogenous ligands of the 4 classes of excitatory amino acid receptors detected in the mammalian CNS, we have measured, using a²²Na⁺ efflux receptor assay, the excitatory activty of 42 brain constituents or analogs and established the receptor specificity of those substances which possess excitatory properties. Among the substances tested were methyltetrahydrofolate and N-acetylaspartylglutamate, two putative ligands of the kainate and glutamate receptors. These compounds were found to have very little or no excitatory activity, respectively. The 8 brain constituents possessing excitatory properties displayed a receptor specificity similar to either that of N-methyl-d-aspartate (e.g.quinolinate) or glutamate (e.g. cysteine sulfinate)_but not of kainate or quisqualate. These results are discussed in relation with the problem of the identification of brain excitatory neurotransmitters.     

The CT (Hounsfield unit) number of brain tissue in healthy infants

It is difficult to correlate CT Hounsfield unit (H. U.) numbers from one CT investigation to another and from one CT scanner to another, especially when dealing with small changes in the brain substance, as in degenerative brain diseases in children. By subtracting the mean value of cerebrospinal fluid (CSF) from the mean value of grey and white matter, it is possible to remove most of the errors due, for example, to maladjustments, short and long-term drift, X-ray fan, and detector asymmetry. Measurements of white and grey matter using these methods showed CT H. U. numbers changing from 15 H. U. to 22 H. U. in white matter and 23 H. U. to 30 H. U. in grey matter in 86 healthy infants aged 0–5 years. In all measurements, the difference between grey and white matter was exactly 8 H. U. The method has proven to be highly accurate and reproducible.     

A device used for study of postural reactions in the quadruped.

A device used for study of postural reactions associated with placing movement in the quadruped is described. The apparatus consists of three basic components; a set of 4 strain gauge platforms on which the quadruped is trained to stand, a restraining device to keep the animal positioned over the strain gauge platforms and two mobile plates which mechanically stimulate the left or the right forelimb to produce the placing movement. The contact placing reaction consists of an early phase of preparatory positioning of the body (a postural adjustment) and a later phase of limb displacement, superimposed on a postural stance, during which the animal lifts its forepaw from the ground and then replaces it on top of one of the mobile plates.     

The developmental characteristics of spontaneous movement in healthy infants

The aim of this study was to evaluate the characteristics of development of spontaneous movements in infants using dynamical systems analysis. The participants were 7 healthy, full-term, newborn infants. A tri-axial accelerometer was used to measure limb acceleration in three-dimensional space. Acceleration signals were recorded on the right wrist, when the infant was in an active alert state, lying in supine. Measurement was carried out every fourth week after birth between the ages of 1 and 5 months old. The recording time was 200 seconds, based on recommendations for this accelerometer. The time-series data was analyzed by non-linear methods using a package (TISEAN) provided with the machine, provided some evidence of non-linear deterministic structure (dimension, maximal Lyapunov exponent). The developmental change in infants' spontaneous movements was shown as "U-shaped", with the base between 2-3 months, and recovering at 4-5 months (4 of 8 infants in dimension, 6 of 8 infants in maximal Lyapunov exponent). Approximately 4-5 months after birth, infants develop voluntary movement, such as reaching for objects.     

Development of selected coagulation factors and anticoagulants in preterm infants by the age of six months

The development of the coagulation and anticoagulation system in preterm infants was assessed, with special emphasis on extremely low birth weight (ELBW) infants and haemorrhagic or other complications after birth. Coagulation factors II (prothrombin), V (FV), VII (FVII) and X (FX) were analysed at birth and at a corrected age of six months. In addition, antithrombin (AT), protein C (PC) and protein S (PS) were measured at six months, and DNA samples were tested for Factor V Leiden (R506Q). Eighty-two infants, with a median gestational age (GA) of 32 weeks (range 24-36) and a median birth weight of 1562 g (range 695-3520), were studied. Fifteen of these were ELBW infants (range 695-1000g). Prothrombin, FV, FVII and FX reached healthy term six-month-old infant activity levels. Prothrombin and FX did not reach adult values; median activity levels remained at 82% and 78%, respectively. During the follow up, the FV and FVII levels of the ELBW infants (GA 24-27 weeks) increased more than those of the preterm infants born with higher GA (p < 0.001). At birth, prothrombin correlated significantly with FV, FVII and FX (p < 0.001). FVII at birth and at six months correlated significantly with PC (p = 0.021 and p = 0.009, respectively). These findings indicate that the gain in the coagulation factor concentrations in infancy is greatest in infants with the lowest GA at birth. Interesting new inter-relations of coagulation factor and physiological anticoagulant levels may indicate that there are still unrecognised pathways in the function of newborn haemostasis.     

Specific postural support promotes variation in motor behaviour of infants with minor neurological dysfunction

This study evaluated the effect of specific postural support on motor behaviour of infants with and without minor neurological dysfunction (MND). The following questions were addressed: (1) Does application of supportive pillows affect the time during which the infant exhibits general movements (GMs) or specific movements? We defined specific movements as movements of specific parts of the body that occur in a specific, recognizable way. (2) Does application of pillows improve the quality of GMs or the repertoire of specific movements? (3) Is a pillow effect affected by neurological condition? Forty healthy, term infants (16 males, 24 females; mean age 3.04m [SD 1.24mo], range 1–5mo) participated in the study. Twenty were neurologically normal and 20 had MND. Spontaneous motor behaviour in a supine position was video‐recorded for 180 seconds in four conditions applied in random order: support by a pillow in (1) the shoulder region, (2) the pelvic region, (3) the shoulder and pelvic region, or (4) no pillow support. Two independent assessors evaluated the quality of GMs. The other movement parameters were assessed with a computer program. Duration of movements was determined and a variation index, consisting of the number of different specific movements in a condition, was calculated. The presence of pillows did not affect the time spent in GMs, specific movements, or GM quality in either group. In neurologically normal infants the shoulder pillow with or without pelvic pillow induced an increase in the variation index (p >0.01), whereas in the infants with MND, all pillow conditions resulted in a substantial increase of the movement repertoire (p >0.001). Our results demonstrate that specific postural support promotes variation in motor behaviour of young infants. This is particularly true for infants with MND.     

Effect of postural changes on arterial baroreflex sensitivity assessed by the spontaneous sequence method and Valsalva manoeuvre in healthy subjects

The objective of this study was to compare the baroreflex sensitivity (BRS) assessed by the new, non-invasive, spontaneous sequence method (BRS-sequence) with the Valsalva manoeuvrebased BRS. Fourteen healthy volunteers were studied in the supine position, during 60° head-up tilt (HUT) and during –30° head-down tilt (HDT). Blood pressure and R-R intervals were continuously and non-invasively recorded using a Finapres device. The BRS-sequence was assessed by analysing the slopes of spontaneously occurring sequences of three or more consecutive beats in which systolic blood pressure and R-R interval of the following beat increased or decreased in the same direction in a linear fashion; it was compared with data obtained during the Valsalva manoeuvre in each position. The time and frequency domain indices of R-R interval variability were also evaluated. The mean difference of BRS between the two non-invasive methods was 3.86 ms/mmHg with a standard deviation of 9.14 ms/mmHg. BRS was decreased during HUT and increased during HDT as assessed by both techniques. The changes in BRS were associated with vagal withdrawal and sympathetic activation during HUT and enhancement in the cardiac vagal tone and reduction in the sympathetic activity during HDT. We conclude that the BRS-sequence technique provides a reliable method to study the neural control of the circulation, although the body position in consecutive measurements needs to be standardized.     

Community mental health centres initiated by the South-Eastern Europe Stability Pact: evaluation in seven countries

Eight community mental health care centres (initiated by the South-Eastern Europe Stability Pact) in Albania, Bosnia-Herzegovina, Croatia, Macedonia, Moldova, Montenegro and Romania were evaluated. Characteristics of patients, patient reported outcomes and patient views of care were assessed in 305 psychiatric patients. Patient characteristics varied across centres, with most patients having long term psychotic disorders. Treatment satisfaction and therapeutic relationships were rated favourably. Subjective quality of life mean scores were rather low, with higher satisfaction with health and dissatisfaction with the financial and employment situation. Being unemployed was the only factor associated with poor quality of life and lower treatment satisfaction. Most developing centres target patients with persistent psychotic disorders. Care appears highly valued by the patients. The findings encourage establishing more centres in the region and call for employment schemes for people with mental illnesses.     

Age-related characteristics and normative values of F waves in healthy infants

ObjectiveTo establish age-related characteristics and normative values of F waves in healthy Chinese infants.MethodsWe studied median, ulnar and tibial nerves on one side distally in 229 healthy Chinese infants (108 males) ranging from 1 to 12 months old.ResultsMinimal F-wave latencies (Fmin) showed a strong negative correlation to the age for median, ulnar and tibial nerves (P < 0.01) but no correlation to the height. Statistical analyses revealed a significant (P < 0.01) decrease of Fmin during the second month of life and no change (P > 0.05) thereafter. Dividing the infants into 1 month old (Group 1) and 2–12 months old (Group 2), normal values (Mean ± SD ms) of Fmin for tibial, median and ulnar nerves consisted of 23.38 ± 1.68, 17.19 ± 0.95 and 16.47 ± 1.06 for Group 1 and 21.42 ± 1.25, 14.50 ± 1.15 and 14.52 ± 0.90 for Group 2.ConclusionF-wave latencies shorten in the 2nd month of life and change little thereafter when age-related maturation counters the concomitant growth of the nerve length.SignificanceF waves can assess infantile neuropathies as a reliable measure, complementing the technically difficult conventional nerve conduction study in short limbs.     

The dependence of the changes in vestibular postural reactions on the information content of visual feedback

Electrical stimulation of the labyrinth in standing subjects induced the body sway predominantly in the frontal plane. Stabilographic response included both early (latency 120-200 ms) and late (200-500 ms) components. Their magnitudes depended on the visual control condition. Maximal responses were recorded in the eyes-closed condition. The response decreased when subjects maintained erect posture with their eyes closed, when fixing a stable visual target, and when tracking the frontal stabilogram displayed on an oscilloscope screen (visual feedback). In all the conditions the early component decreased by 10-20 percent whereas the late one decreased by 50-70 percent. Visual fixation of a small light stationary relative to the head did not influence the response. On the other hand, information on the direction of the expected body sway given in the visual fixation condition resulted in a considerable and approximately equal decrease of the two components (by 70-80 percent). It is concluded that the early and late components of the vestibulo-motor response are mediated via different mechanisms with specific temporal and functional characteristics.     

Electro-physiological evaluation of nerves during reactions in leprosy

Forty-two patients with leprosy (7 with tuberculoid type, 30 borderline, 5 lepromatous) were studied electrophysiologically during reactions. Thirty-three had type I reactions while 9 had type II reactions. Each patient received 60 mg/day prednisolone tapered over a 6-week period. Motor conduction studies were performed on one clinically affected and one unaffected nerve and were repeated 12 weeks after the beginning of steroid therapy. Significant motor conduction abnormalities were observed in 14 affected (33.3%) and 8 unaffected nerves (19.1%). The majority of these nerves were in patients with borderline leprosy having type I reactions. Following steroid therapy, nerve function improved in 14 affected (33.3%) and 20 unaffected nerves (47.66%). However, 5 affected (10.2%) and 12 unaffected nerves (28.5%) showed a worsening of nerve function following steroid therapy. The majority of the nerves that showed improvement with steroid therapy had type I reactions, while those that showed deterioration had type II reactions. Steroids improved nerve function mainly in patients with type I reactions. Their role in patients with type II reactions remains debatable.     

Spontaneous movements in the supine position of healthy term infants and preterm infants with or without periventricular leukomalacia

Aim: The individual motor elements presumed to be essential for motor development were determined from spontaneous movements involving the entire body of normal term and preterm infants. Then, diagnostic items for motor abnormality in infants with periventricular leukomalacia (PVL) were investigated. Methods: Video recordings of 24 healthy term infants, 21 normal preterm infants (8 males, 13 females; median gestational age 30 weeks; median birth weight 1216 g) and 14 preterm infants with PVL (6 males, 8 females; median gestational age 30 weeks; median birth weight 1360 g) were analyzed. Results: In healthy term infants, predominant shoulder rotation was noticed until 1 month of age. After 2 months of age, isolated movements of the shoulder, elbow, hip, knee, and ankle frequently emerged. In preterm infants with PVL at the corrected age of 2 months, startle response and predominant shoulder rotation were more frequently seen and isolated neck, shoulder, elbow, hip, knee, and ankle movements were less frequently seen than in the normal preterm infants (Fisher’s exact test, p < 0.025). Interpretation: At 2 months of age, isolated movements evolve, and their failure to occur is suggested to be a useful sign for the diagnosis of cerebral motor disorders.     

Clinical and cerebral angiographic evolutions of idiopathic progressive occlusive disease of the circle of Willis ("moyamoya" disease) in children

In 33 pediatric cases of idiopathic progressive occlusive disease of the circle of Willis (so-called moyamoya disease), clinical features and CAG findings were studied with emphasis on their evolutionary aspects. The subjects were clinically classified as follows; 23 cases of pure transient ischemic attacks (TIA), one presenting purely with infarct, one mixed TIA and epileptic, two mixed TIA + infarct, and 6 mixed epileptic and infarct. The core symptom of the TIA type is a recurrent unilateral or alternating unilateral paresis persisting for minutes or hours. Frequently hyperpnea provoked a TIA. Follow-up observation of the TIA type patients for an average of 6 yrs 11 mos shows that about half the subjects became completely free of symptoms and the other half mostly improved considerably. In contrast, all patients not presenting purely with TIA ("non-TIA" type) still had persistent neurological deficits after a mean interval of 6 yrs 4 mos from the onset. The CAG findings in most cases belonged to stage III according to Suzuki's classification. Therefore the authors subdivided stage III into 3 substages, IIIa, IIIb and IIIc. The longer the duration of the disease up to the CAG examination, the more advanced was the CAG stage. Repeat CAGs examined after a mean interval of 2 yrs 11 mos demonstrated the same stage in 32%, and progress by one or two stages in 55% and 14% of the sides examined, respectively.