Limited motor performance and minor neurological dysfunction at school age

Aim: To investigate the relationship between motor performance and minor neurological dysfunction (MND) at school age. Methods: Two hundred and fifty‐three children (158 boys, 95 girls; mean age 8 years and 7 months) of whom 167 children received mainstream education and 86 children special education were neurologically examined according to Touwen. Special attention was paid to the severity of MND (simple or complex form) and type of dysfunction. Motor performance was assessed with the Movement Assessment Battery for Children (MABC), a parental questionnaire (Developmental Coordination Disorder Questionnaire; DCD‐Q) and a teacher’s questionnaire (Motor Observation Questionnaire for Teachers; MOQ‐T). Results: Total scores of MABC, DCD‐Q and MOQ‐T were strongly related to the severity of MND and to dysfunctional coordination and fine manipulation. Mild dysfunction in posture and muscle tone was only weakly related to limited motor performance. Children with a MABC score < 5th percentile showed significantly more often complex MND than children with scores between the 5th and 15th percentile or >15th percentile (54% vs 17% and 10%). Conclusion: Limited motor performance is related to the severity and type of MND. Coordination problems and fine manipulative disability are strongly related to poor motor performance, mild dysfunctions of posture and muscle tone to a lesser extent.     

Minor neurological dysfunction and cognition in 9-year-olds born at term

Background

In children with developmental disorders, motor problems often co-occur with cognitive difficulties. Associations between specific cognitive deficits underlying learning problems and minor neurological dysfunction (MND) are still unknown.

Aims

To assess associations between specific types of MND as clinical markers of non-optimal brain function and performance in specific cognitive domains.

Study design

Part of a randomized controlled trial.

Subjects

Three hundred and forty one 9-year-old children born at term (177 boys, 164 girls).

Outcome measures

Children were neurologically assessed to detect eight types of MND: mild dysfunction in posture and muscle tone, reflexes, coordination, fine manipulative ability, sensory function, cranial nerve function, choreiform dyskinesia and excessive associated movements. Cognitive function in the domains of attention, memory and language was evaluated using the Test of Everyday Attention for Children (TEA-Ch), a developmental neuropsychological assessment (NEPSY) and the Children's Memory Scale.

Results

Fine manipulative disability and coordination problems were associated with lower scores on attention, memory and learning and language, other types of MND were not. Girls with coordination problems performed significantly worse on attention/executive function than those without this dysfunction; however, in boys, such association was absent.

Conclusion

Particularly, fine manipulative disability and coordination problems were associated with worse cognitive function in the domains of attention, learning and memory and language. Previous and present data suggest a minor sex difference in neurocognitive associations: in girls dysfunction of the cerebello-thalamo-cortical pathways may be associated with cognitive deficits, while in boys cognitive impairment may be associated with dysfunction of cortico-striato-thalamo-cortical pathways.     

Are abnormal fidgety movements an early marker for complex minor neurological dysfunction at puberty?

BACKGROUND: Prechtl's method on the qualitative assessment of general movements (GMs) is a powerful tool for early and specific prediction of cerebral palsy. However, it is uncertain whether the GM assessment can be used to predict mild neurological impairment. AIMS: To determine whether the quality of general movements (GMs) from the age of 3 to 5 months, i.e. fidgety movements, is related to the presence of complex minor neurological dysfunctions (MND) 13 to 15 years later. STUDY DESIGN: Prospectively collected data on the quality of GMs during infancy were retrospectively analysed on the basis of MND at puberty. SUBJECTS: Twenty-eight participants (14 girls and 14 boys) with a median gestational age of 40 weeks (range: 35 to 42 weeks) and an appropriate birth weight (median 3390 g; range 1900 to 4200 g). OUTCOME MEASURES: Touwen's neurological examination. RESULTS AND CONCLUSIONS: Abnormal fidgety movements were not related to later complex MND, but to fine manipulative disabilities (p<0.05). Normal fidgety movements, which are continually present in the whole body, might be required for optimal calibration of the proprioceptive system.     

Quality of reaching and postural control in young preterm infants is related to neuromotor outcome at 6 years

A substantial proportion of the "apparently normal" preterm infants exhibit minor and moderate dysfunctions in neuromotor outcome as they grow older. Birth characteristics, minor abnormalities on the neonatal ultrasound scan of the brain, and motor milestones have only limited value in the early detection of these children. The aim of the present study was to investigate whether nonoptimal reaching and relatively immobile postural behavior at an early age are associated with dysfunctional neuromotor and behavioural development at school age. The preterm children and full-term children of the present follow-up study participated in a previous study on the characteristics of reaching kinematics and the kinetics of posture at 4 and 6 mo corrected age. At the age of 6 y, the children were re-assessed by means of the Touwen neurologic assessment, the Movement ABC, and the Child Behavior Check List. The results demonstrated that in preterm children without cerebral palsy, a lack of successful reaching at 4 mo and a nonoptimal quality of reaching at 6 mo are related to the development of a complex form of minor neurologic dysfunction (MND) and fine manipulative disability at 6 y. Thus, these early signs indicate the presence of clinically significant brain dysfunction. A relatively immobile postural behavior at 4 mo was associated with simple MND, coordination problems, and at 6 mo with a worse score on the Movement ABC and internalizing behavior. This suggests that a relatively immobile postural behavior points to a mild form of brain dysfunction.     

Health related quality of life in disorders of defecation: the Defecation Disorder List

Background: Constipation and encopresis frequently cause problems with respect to emotional wellbeing, and social and family life. Instruments to measure Health Related Quality of Life (HRQoL) in these disorders are not available. Methods: A disease specific HRQoL instrument, the "Defecation Disorder List" (DDL) for children with constipation or functional non-retentive faecal soiling (FNRFS) was developed using accepted guidelines. For each phase of the process, different samples of patients were used. The final phase of development included 27 children. Reliability was assessed in two ways: internal consistency of domains with Cronbach''s alpha, and test-retest reliability with intra-class correlation coefficients (ICC). To assess validity, comparable items and domains were correlated with Tacqol, a generic HRQoL instrument for children (TNO-AZL). Results: In the final phase of the development, 27 children completed the instrument. It consisted of 37 items in four domains. The response rate was 96%. Reliability was good for all domains, with Cronbach''s alpha values ranging from 0.61 to 0.76. Measures of test-retest stability were good for all four domains with ICCs ranging from 0.82 to 0.92. Validity based on comparison with the Tacqol instrument was moderate. Conclusion: The DDL is promising as a measure of HRQoL in childhood defecation disorders.     

Psychometric properties of the Swedish PedsQL, Pediatric Quality of Life Inventory 4.0 generic core scales

Aim:  To study the psychometric performance of the Swedish version of the Pediatric Quality of Life Inventory (PedsQL) 4.0 generic core scales in a general child population in Sweden.
Methods:  PedsQL forms were distributed to 2403 schoolchildren and 888 parents in two different school settings. Reliability and validity was studied for self-reports and proxy reports, full forms and short forms. Confirmatory factor analysis tested the factor structure and multigroup confirmatory factor analysis tested measurement invariance between boys and girls.
Results:  Test-retest reliability was demonstrated for all scales and internal consistency reliability was shown with α value exceeding 0.70 for all scales but one (self-report short form: social functioning). Child-parent agreement was low to moderate. The four-factor structure of the PedsQL and factorial invariance across sex subgroups were confirmed for the self-report forms and for the proxy short form, while model fit indices suggested improvement of several proxy full-form scales.
Conclusion:  The Swedish PedsQL 4.0 generic core scales are a reliable and valid tool for health-related quality of life (HRQoL) assessment in Swedish child populations. The proxy full form, however, should be used with caution. The study also support continued use of the PedsQL as a four-factor model, capable of revealing meaningful HRQoL differences between boys and girls.     

Health related quality of life in disorders of defecation: the Defecation Disorder List.

BACKGROUND: Constipation and encopresis frequently cause problems with respect to emotional wellbeing, and social and family life. Instruments to measure Health Related Quality of Life (HRQoL) in these disorders are not available. METHODS: A disease specific HRQoL instrument, the "Defecation Disorder List" (DDL) for children with constipation or functional non-retentive faecal soiling (FNRFS) was developed using accepted guidelines. For each phase of the process, different samples of patients were used. The final phase of development included 27 children. Reliability was assessed in two ways: internal consistency of domains with Cronbach's alpha, and test-retest reliability with intra-class correlation coefficients (ICC). To assess validity, comparable items and domains were correlated with Tacqol, a generic HRQoL instrument for children (TNO-AZL). RESULTS: In the final phase of the development, 27 children completed the instrument. It consisted of 37 items in four domains. The response rate was 96%. Reliability was good for all domains, with Cronbach's alpha values ranging from 0.61 to 0.76. Measures of test-retest stability were good for all four domains with ICCs ranging from 0.82 to 0.92. Validity based on comparison with the Tacqol instrument was moderate. CONCLUSION: The DDL is promising as a measure of HRQoL in childhood defecation disorders.     

Low birthweight and neuromotor development: a population based, controlled study

The aims of the study were to investigate: (a) the relationship between low birthweight (LBW) and preschool neuromotor development; and (b) the predictive value of various pre-, peri-, and neonatal factors for neuromotor development in LBW pre-school children. A population based sample of 144 5-year-old LBW children (birthweight <2000g) with no major handicaps was compared with a random sample of 163 normal birthweight term controls. Using the Peabody Developmental Motor Scales, impaired performance on the balance scale was seen more often in LBW boys than in controls (odds ratio 5.5, 95% CI 1.5-20.3), while performance on the eye-hand coordination and locomotor scales was comparable for the two groups. LBW girls were comparable to controls on all these scales. On neurological examination, an increased frequency of minor neurological signs was found in LBW boys, while increased ankle tone and/or leg hyperreflexia was more common in LBW girls compared to controls. Small head circumference at birth was associated with an increased frequency of minor neurological signs in LBW boys, and lack of breastmilk in the neonatal period with impaired balance in LBW boys. None of the other pre-, peri- or neonatal factors were predictive of neuromotor development. We conclude that motor functions essential for daily activities are intact in most LBW preschoolers.     

Test-retest and inter-rater reliability for the Comprehensive Developmental Inventory for Infants and Toddlers diagnostic and screening tests

BACKGROUND: Reliability information for the Comprehensive Developmental Inventory for Infants and Toddlers diagnostic (CDIITDT) and screening tests (CDIITST) is inadequate. AIM: To assess the test-retest and inter-rater reliability of the CDIITDT and CDIITST. STUDY DESIGN: A repeated measures design was selected. SUBJECTS: Non-disabled term (n=15; mean age 8.4+/-1.6 months) and preterm infants (n=16; mean age 9.3+/-2.9 months), and children with developmental disabilities (n=15; mean age 24.7+/-11.8 months) were recruited. A single rater assessed the children twice in 3 days to examine the test-retest reliability; and a second rater observed and scored performance while the same rater conducted the first assessment for the inter-rater reliability analysis. OUTCOME MEASURES: The raw score, developmental age (DA) and developmental quotient (DQ)/Z score for the six subtests, two motor subdomains and the whole test were used as outcome measures for the CDIITDT and CDIITST. RESULTS: The test-retest reliabilities for the CDIITDT were rated good for the three pediatric groups (ICC 0.76-1.00), with the exception of moderate ratings for the self-help subtest for the term infants and for the social, self-help and fine-motor DQs for the preterm group. The CDIITDT inter-rater reliabilities were good for the three groups (ICC 0.76-1.00), with the exception of only moderate reliability for the cognitive DQs for the preterm infants. The reliabilities for the whole CDIITST for the three groups were high (ICC 0.93-1.00). CONCLUSION: The reliabilities for the whole CDIITDT and its various subtests and the whole CDIITST are acceptable for clinical use.     

Neurological assessment at five years of age in infants born preterm

AIM: To evaluate the agreement between Touwen's neurological examination and a derived simplified one, created to be applied at the age of 5 y to infants born preterm. METHODS: 185 children born at a gestational age (GA) of <33 wk and/or with a birthweight <1501 g, free of cerebral palsy, underwent Touwen's neurological examination at a mean age of 5 y and 8 mo (5-6.5 y). One-hundred and seventy had a full examination and were included into the study. They were born at a mean GA of 30 wk (range 24-35 wk) with a mean birthweight of 1250 g (range 600-2690 g). A simplified examination, based on the clinical experience of two of the authors, was created a priori. The data were reviewed retrospectively and the concordance between the two forms was assessed. The reviewers were blinded to the original categorization from the long form. RESULTS: On the basis of the original Touwen's neurological examination, the 170 children were classified into 122 with a normal neurological examination, 41 with grade 1 minor neurological dysfunction (MND) and 7 with grade 2 MND, giving 28% of the cohort with MND. The concordance between the two forms was excellent, with an agreement in 169 out of 170 subjects. None of the infants with the most complex form of MND was misclassified. CONCLUSION: The simplicity of this examination could allow its diffusion and its use in follow-up programmes. It could improve the quality of routinely collected follow-up data of preterm neonates.     

Motorische Leistungsfähigkeit im Kindes- und Jugendalter

The development of motor competencies is an important component of healthy development. In this paper, the motor fitness data of children and adolescents age 4–17 years are presented and analyzed. Data were obtained from the “Motorik-Modul” (MoMo) study, a representative cross-sectional sample of the 4–17-year-old boys and girls from Germany (N=4,529). Motor fitness was assessed using a standardized test profile. Conditional performance increase in both sexes during childhood, with a gender-specific differentiation in favor of boys at the onset of puberty. Over the course of adolescence, girls show only a slight performance increase. Regarding gross motor coordination, strong performance gains are getting evident in early and middle childhood. However, in late childhood and early adolescence, performance is characterized by decreasing growth rates; boys and girls of all ages show comparable coordinative performances. Girls show better flexibility than boys, in both sexes only minor performance fluctuations are getting obvious with age. The present motor fitness data show broad agreement with the literature but are more current and more resilient due to their comprehensive representativeness.     

VI. Somatic pubertal development.

The pubertal development of 212 randomly selected Swedish urban children has been investigated as part of a prospective longitudinal study of growth and development. The timing and pattern of pubertal changes were in agreement with the findings in other contemporary studies. The good agreement with data on pubertal development reported in other investigations of Swedish children indicates that the present sample was representative of contemporary Swedish children. Two procedures of assessment of secondary sex characters - clinical examination and whole-body photography - have been compared and contrasted. A clinical examination is less laborious and resource-consuming and also has psychological advantages but should be supplemented in boys by the estimation of testicular volume (orchidometry). In girls the two methods have similar precision and reliability. The first pubertal changes may be observed before 9 years in girls (breast development) and before 10 years in boys (genital development). On average the first change takes place about one year earlier in girls than in boys. Peak height velocity (PHV) is an early event during puberty in girls and a relatively late event during puberty in girls and a relatively late one in boys, the sex difference in mean age being about two years. In girls, menarche is a late event, always occurring after PHV. At the age of 13-14 years some boys and girls have not yet begun theri pubertal development, while others have reached the adult stage.     

中文版北极星移动评价量表在Duchenne型肌营养不良症患儿的信度和效度研究

目的：确定中文版北极星移动评价量表（NSAA）应用在Duchenne型肌营养不良症（DMD）患儿的信度和效度。方法：纳入对象为2014年1月至2016年1月在复旦大学附属儿科医院康复科接受功能评估的DMD患儿,均经基因检测或肌肉活检明确诊断,能独立行走≥10 m,无严重认知障碍。2名物理治疗师同时对DMD患儿进行测试,检验不同测试者间的信度;同一评价者在第1次评价后3~7 d进行第2次评价,检测重测信度;采用《国际功能、残疾和健康分类》儿童和青少年版（ICF-CY）的类目编码与NSAA的项目概念进行关联,确定NSAA的内容效度;通过分析NSAA的分值与6 min步行距离的相关性进行关联效度分析。结果：2个治疗师对20名DMD男孩的不同测试结果间的信度分析显示,NSAA原始分和线性分信度ICC分别为0.96和0.97;1名治疗师前后3～7 d重测16名DMD男孩,NSAA的原始分和线性分具有很好的重测信度（ICC=0.96）;NSAA17个项目共与8个ICF-CY编码发生了20次关联,8个编码都属于d4（移动）下属,表明NSAA的评价内容主要聚焦于DMD患儿活动能力中的移动能力;143例DMD男孩的NSAA原始分和线性分与6min步行距离具有中等程度的相关性（r分别为0.40和0.38）。结论：中文版NSAA量表无论是原始分还是线性分都具有良好的心理测量学特性,结合其他的评价指标,NSAA可以有效地评价中国DMD男孩的活动能力。     

The long-term significance of neurological findings at toddler's age

Eighty neurologically abnormal infants were re-examined neurologically at 1 1/2, 4 and 9 years of age. Eighty normal newborn were seen again at 1 1/2 and 4 years. Special attention was paid to the presence of minor neurological dysfunction (MND). Changes in neurological classification occurring during the period of time in question are discussed. Neurological handicap could be spotted reliably at 18 months. The frequency of MND increases with age, however.     

Reliability of the Neonatal Neurobehavioral Examination — Chinese version

A Chinese version of the Neonatal Neurobehavioral Examination (NNE-C) was applied to 15 high-risk infants and five normal term infants for investigation of reliability. The infants were assessed by three physical therapists to examine inter-rater reliability and reassessed by one of the therapists within 2 days to examine test-retest reproducibility. The internal consistency of the NNE-C scale was high, with an alpha coefficient of 0.84. The inter-rater reliability was high for item scores (kappa coefficients > 0.75 for 81% of the items) and for section and total scores (all intraclass correlation coefficients > 0.80). The test-retest reproducibility was moderate for item scores (kappa coefficients > 0.40 for 85% of the items) and was high for section and total scores (all intraclass correlation coefficients > 0.80). We conclude that the NNE-C scale is clinically feasible and reliable for the evaluation of neurobehavioral functions of high-risk and normal term infants in Chinese-speaking societies.     

Preterm or small-for-gestational-age infants

In 166 full term, small-for-gestational-age (FT-SGA), 53 preterm, appropriate-for-gestational-age (PT-AGA), 27 PT-SGA and 206 FT-AGA infants a neurological examination at the age of 6 years was carried out. Data were collected on behaviour and school achievement. Major and minor neurological abnormalities were more frequent in the three low birth weight groups, especially in the PT-SGA group. Multivariate analysis showed that the development of major and minor neurological abnormalities was explained by a varying set of risk factors, in which besides prematurity and growth retardation, neonatal neurological condition, social class, neonatal course and interval complications were preponderant. The results suggest a temporal difference in potentially harmful factors: for neurological handicap early in pregnancy, for minor neurological dysfunction (MND) the second half of gestation and the first 2 years of life. No striking behavioural differences were found between the three low birth weight groups and the FT-AGA group; behaviour was related to neonatal and follow-up neurological condition, sex, gestational age and birth weight to a limited extent only. Three (4%) of the preterms entered a special school (already at the age of 6). School achievement was mainly related to the present neurological condition and social class, which underlines the importance of the latter.Abbreviations ADL activities of daily life - AGA appropriate-for-gestational age - FT full term - LBW low birth weight - MND minor neurological dysfunction - OOS obstetrical optimality score - OR Odds ratio - PT preterm - SGA small-forgestational age - VLBW very low birth weight     

Static and dynamic standing balance: test-retest reliability and reference values in 9 to 10 year old children

Introduction Based on the literature, reliability reports and normative data for bilateral stance assessments in elementary schoolchildren are limited. The present study was designed to report test-retest reliability and reference values for postural stability in 9 to 10 years old schoolchildren using the Balance Master system.Materials and methods Twenty children participated in the reproducibility study (mean age 10.1±0.7) including test and retest measurement with a one-week interval. The modified clinical test of sensory interaction on balance (mCTSIB) quantified children’s static standing balance. The test for the limits of stability (LOS) measured dynamic standing balance. The study sample to determine reference values consisted of 99 children (mean age 9.8±0.5).Results The ICCs for inter-item reliability of the four sensory conditions of the mCTSIB showed fair to excellent reliability (ICCs between 0.62 and 0.80). The reproducibility between test and retest was non-significant for the condition ‘firm surface with eyes closed’ (ICC of 0.37), fair to good for the three other sensory conditions (ICCs between 0.59 and 0.68), and excellent for the composite sway velocity (ICC of 0.77). For all LOS parameters, the significant ICCs showed fair to good reproducibility (ICCs between 0.44 and 0.62), with the exception of the non-significant ICC for the composite reaction time. The ICCs for the separate LOS parameters showed fair to good and excellent reliability for nine parameters (ICCs between 0.46 and 0.81), while 11 separate LOS scores did not demonstrate significant ICCs.Discussion Analysing reference values, girls performed better on all the composite balance parameters compared to boys, with the exception of reaction time and movement velocity. No differences were found on standing balance scores between 9 and 10 year olds.Conclusion In conclusion, the Balance Master showed fair to good reliability for most postural parameters in 9 to 10 year olds. The current data on postural control in children aged 9 to 10 years are relevant for research in other domains within the clinical field, like obesitas and developmental coordination disorder or in relation to back pain prevalence at early age.     

Neurobehaviour of school age children born to diabetic mothers

AIM—To study the neurobehavioural effects that diabetes during pregnancy might have on children by school age.METHODS—The neurobehavioural function of 57 school age children born to 48, well controlled diabetic mothers was compared with 57control children matched for age, birth order, and parental socioeconomic status, using several cognitive, behavioural, sensory and motor neurological tests.RESULTS—The IQ scores of the index group children were similar to those of control children (117.7±13.4 vs 118.5±10.1). There were no differences between the groups in various sensory motor functions. However, the index group children performed less well than the controls on indices of fine and gross motor functions, as observed on the Bruininks-Oseretzky test of motor proficiency. The scores of children born to diabetic mothers were higher than controls on the Touwen and Prechtl neurological examination. They also performed worse in the Pollack tapper test which is designed to detect minor neurological deficits, inattention, and hyperactivity. The index children had higher scores on the Conners abbreviated parent-teacher questionnaire which measures hyperactivity and inattention. There was a negative correlation between the performance of the index group children on various neurodevelopmental and behavioural tests and the severity of hyperglycaemia, as assessed by blood glycosylated haemoglobin and acetonuria.CONCLUSIONS—Diabetes during pregnancy adversely affects some fine neurological functions in children at school age, but not their cognitive scores. These effects are not correlated with the degree of glycaemic control.