Self‐care and mobility skills in children with cerebral palsy,related to their manual ability and gross motor function classifications

Aim The aim of this study was to investigate the acquisition of self‐care and mobility skills in children with cerebral palsy (CP) in relation to their manual ability and gross motor function. Method Data from the Pediatric Evaluation of Disability Inventory (PEDI) self‐care and mobility functional skill scales, the Manual Ability Classification System (MACS), and the Gross Motor Function Classification System (GMFCS) were collected from 195 children with CP (73 females, 122 males; mean age 8y 1mo; SD 3y 11mo; range 3–15y); 51% had spastic bilateral CP, 36% spastic unilateral CP, 8% dyskinetic CP, and 3% ataxic CP. The percentage of children classified as MACS levels I to V was 28%, 34%, 17%, 7%, and 14% respectively, and classified as GMFCS levels I to V was 46%, 16%, 15%, 11%, and 12% respectively. Results Children classified as MACS and GMFCS levels I or II scored higher than children in MACS and GMFCS levels III to V on both the self‐care and mobility domains of the PEDI, with significant differences between all classification levels (p<0.001). The stepwise multiple regression analysis verified that MACS was the strongest predictor of self‐care skills (66%) and that GMFCS was the strongest predictor of mobility skills (76%). A strong correlation between age and self‐care ability was found among children classified as MACS level I or II and between age and mobility among children classified as GMFCS level I. Many of these children achieved independence, but at a later age than typically developing children. Children at other MACS and GMFCS levels demonstrated minimal progress with age. Interpretation Knowledge of a child’s MACS and GMFCS level can be useful when discussing expectations of, and goals for, the development of functional skills.     

AV Node Reentry Tachycardia in Infants

The purpose of this study was to determine the frequency of atrioventricular (AV) node reentry tachycardia in infants undergoing transesophageal electrophysiological study for paroxysmal tachycardia. The records of all 52 infants < 1-year-old with structurally normal hearts who underwent transesophageal study for paroxysmal tachycardia over a 3-year period were reviewed. Those with a diagnosis of AV node reentry tachycardia underwent complete data review, and follow-up of > 12 months was obtained. Six of 52 infants had a diagnosis of the common type of AV node reentry tachycardia. Tachycardia was diagnosed at a mean age of 2.1 months (range 1 day to 10 months), and 3 of 6 underwent transesophageal study within the first month. Although no patient had structural heart disease, three patients had significant noncardiac disease. Follow-up of 15–38 months (mean 24 ± 7.8) revealed recurrences in 2 of 6 patients. The mean tachycardia cycle length was 240 ms (range 200–310 ms), and the transesophageal ventriculoatrial intervals ranged from < 30 to 55 ms. All patients had an inducible reentrant tachycardia with a ventriculoatrial interval that remained constant even when tachycardia cycle length increased following verapamil or adenosine administration, or decreased following isoproterenol infusion. Five of 6 had evidence for discontinuous AV node conduction curves. In our patients the substrate for AV node reentry tachycardia was present early in life, and AV node reentry tachycardia can be a clinical problem even in the newborn period.     

Immunity to Brugia pahangi in athymic nude and normal mice: eosinophilia, antibody and hypersensitivity responses

Congenitally athymic nude (nu/nu) mice, immunologically reconstituted by thymus grafting before inoculation with infective larvae, and mice heterozygous for the nu gene (nu/+), mounted potent protective humoral and cellular immune responses to Brugia pahangi. Although responses were not identical, both groups of mice produced IgM, IgG and IgE antibodies specific for adult worm antigen (S-Ag) present in a crude aqueous extract, made immediate and delayed hypersensitivity footpad swelling responses when challenged with S-Ag and eliminated their infection in the early larval stages. Heterozygotes also exhibited a marked eosinophilia which peaked coincident with larval killing. In contrast, thymus grafting of patent nudes had no effect upon microfilaraemias or adult worm burdens and did not completely protect against a challenge larval inoculum although antibodies specific for S-Ag were produced. With the occasional exceptions of moderate immediate footpad swelling and very low titres of IgM specific for S-Ag, no specific immune responses to B. pahangi were found in ungrafted nude mice which allowed full development of adult worms and supported patent infections.     

Early head growth: relation with IQ at 8 years and determinants in term infants of low and appropriate birthweight

Aim  To investigate the relation between head growth at different periods and IQ at 8 years, and to identify factors associated with more rapid head growth.
Method  Two parallel cohorts of term low birthweight (LBW) and appropriate birthweight (ABW) infants were enrolled at birth in northeast Brazil. Anthropometric measurements were made at birth, 2 months, 6 months, 12 months, 24 months, and 8 years. Cognition was assessed at 8 years ( n =164) with the Wechsler Intelligence Scale for Children. Multivariable analysis with a two-stage residual model was used to relate head growth between successive time points with IQ.
Results  Mean birthweight was 2.35kg (SD 0.15) in the LBW group (33 males, 50 females), and 3.21kg (SD 0.15) in the ABW group (28 males, 53 females). Mean gestational age was 38.8 weeks (SD 1.4) and 40.0 weeks (SD 1.3) respectively. In the LBW group, head growth from birth to 2 months and from 2 to 6 months, conditional on previous size, were significant independent predictors of IQ at 8 years. Conditional head growth from 6 months to 8 years and head size at birth were unrelated to IQ. In the ABW group there was no significant relation between conditional head growth and IQ for any period. Determinants of more rapid head growth from birth to 6 months in LBW infants were maternal height and rate of infant weight gain.
Interpretation  Head growth from birth to 6 months in term LBW infants is more important than prenatal or later postnatal head growth in predicting IQ at 8 years.     

Stability of motor problems in young children with or at risk of autism spectrum disorders,ADHD, and or developmental coordination disorder

Aim The aim of this study was to investigate the stability of motor problems in a clinically referred sample of children with, or at risk of, autism spectrum disorders (ASDs), attention‐deficit–hyperactivity disorder (ADHD), and/or developmental coordination disorder (DCD). Method Participants were 49 children (39 males, 10 females; mean age 5y 6mo, SD 10mo) with various developmental problems, a Movement Assessment Battery for Children (M‐ABC) score on or below the 15th centile, and an IQ of 70 or more. Sixteen children were at risk of developing ADHD, 15 children had a diagnosis of, or were at risk of developing ASD, and 18 children had neither diagnosis. Children were reassessed 2 to 3 years later. Results At follow‐up (mean age 7y 11mo; SD 1y), the mean M‐ABC score was significantly increased, and in 22 children was no longer below the 15th centile. A general linear model to compare the difference in M‐ABC scores in the three groups of children demonstrated a significant difference between groups (p=0.013), with the age at the initial assessment as a significant covariate (p=0.052). The group of children with or at risk of ASD showed less improvement in motor performance. Interpretation Motor problems among preschool age children are not always stable, but appear to be so in most children with ASDs.     

Hearing screening in the newborn intensive care nursery: Comparison of methods

Patients in the neonatal intensive care unit were tested by hearing screening tests including auditory brain stem response (ABR), transient and distortion-product otoacoustic emissions (TEOAEs and DPOAEs), and acoustic stapedius reflex (ASR), and by middle ear function tests including multifrequency tympanometry and pneumatic otoscopy. Pass rates on hearing tests were 75% to 89%. TEOAEs produced the lowest pass rate, and DPOAEs the highest. TEOAE, DPOAE, or ASR testing followed by ABR testing of initial failures produced pass rates of about 90%. The most efficient combination was DPOAEs followed by ABR. Pass rates tended to decrease with age. Of patients who failed 226-Hz and 678-Hz tympanometry, 30% to 67% passed hearing tests, suggesting a high false-positive rate for these immittance tests. The 3 ears that failed the 1000-Hz tympanogram failed all hearing tests. Many ears were abnormal by pneumatic otoscopy but passed hearing tests, suggesting that the usual ear examination criteria may not apply to infants.     

The Concepts of Successful and Positive Ageing

Social scientists frequently refer to the ‘greying’of the population in the west, the extension of the averagelifespan to around the age of 76, and the projected increasesin the numbers of people aged 85 and over, with the ensuingproblems of chronic illness and disability that often accompanyvery old age. ¹Increasing interest is being expressed in positiveaspects of ageing: given the increases in life expectancy duringthis century, is it resulting in a life worth living? Concernis heightened by the estimate that, although most people aged65+ live in their own homes and are relatively healthy and independent,years of disability can begin as early as 60 years. Conversely,some researchers and policy makers feel that enough time hasbeen spent on the negative aspects of ageing and that the balanceshould be addressed by analysing successful, or positive ageing(sometimes defined in terms of an overlapping but separate dimension‘health-related quality of life’), with the aimof promoting well-being for future generations.     

Weight Gain in Pregnancy

The amount of weight that women are advised to gain during pregnancy has changed significantly in the past few decades. In the past, recommendations were aimed at curtailing weight gain because of problems surrounding delivery (i.e., cephalopelvic disproportion or toxemia). More recently, concern for development of maternal obesity has been used to justify curtailed weight gain. Factors that should be considered for determining the appropriate gain for an individual woman are discussed.