Motor incoordination in children born preterm: coordinated efforts needed

Healthy preterm infants: global motor coordination and early intervention

Introduction Studies recommend a participation by preterm children (PT) in Early Intervention Programs (EIP), as the coordination dysfunctions appear to occur more frequently in premature school children. Objectives Describe the global motor coordination (MC) in PT children that participate in an EIP; verify the difference in MC between the sexes and correlate the coordination results of PT children and those with gestation age (GA) and the birth weight (BW); and compare the results of MC between PT children and full-term children (FT). Materials and methods 57 children (5-6 years old) – 20 PT that participate in EIP, and 37 FT. For the analysis of MC, it was used the Körperkoordination für Kinder (KTK) – Test of Body Coordination for Children. To the comparisons, it was used independent-samples T-test and the Mann-Whitney test (α = 0.05), and the Pearson correlation to verify the influence of GA and BW in the coordinated results. Results 80% of the PT children presented normal MC; the girls demonstrated a better performance on the tasks balance beam and lateral jumps and with regard to the MC corresponding to the sum of the gross scores on the tasks; the GA and BW did not influence MC; and, there was no difference between MC in PT and FT children. Conclusion The PT children presented, in their majority, satisfactory levels of MC, and the girls presented better results. In addition, the GA and BW did not interfere in the MC results. Lastly, there was no difference in the coordination performance between PT and FT children.

Cerebral palsy and developmental coordination disorder in children born preterm

Children born early (<37 weeks of gestation) are at high risk of a range of motor impairments due to a variety of biological and environmental risk factors. Cerebral palsy occurs more frequently in those children born preterm, with the risk increasing with decreasing gestational age. Mild and moderate motor impairments, consistent with developmental coordination disorder, occur in almost half of those children born preterm and include difficulties with balance, manual dexterity and ball skills. All forms of motor impairment are associated with comorbidities, which may have a greater effect on quality of life, academic achievement and participation in extracurricular activities than the motor impairment itself. Infants at risk of motor impairment can be identified in early infancy with a combination of clinical assessment tools and perinatal risk factors. However, the reliable diagnosis of motor impairment requires follow-up into early childhood and it is important to ensure that the appropriate intervention is implemented.

Developmental coordination disorder: a review and update

Present in approximately 5-6% of school-aged children, developmental coordination disorder (DCD) is a neuromotor disability in which a child's motor coordination difficulties significantly interfere with activities of daily living or academic achievement. These children typically have difficulty with fine and/or gross motor skills, with motor performance that is usually slower, less accurate, and more variable than that of their peers. In this paper, we review the history of various definitions leading up to the current definition of DCD, prevalence estimates for the disorder, etiology, common co-morbidities, the impact of DCD on the child's life, and prognosis. As well, we briefly describe current interventions for children with the disorder and results of recent neuroimaging studies of the brains of children with DCD, including research by the authors of this paper.

Functional magnetic resonance imaging of the sensorimotor system in preterm infants

OBJECTIVE

Preterm birth at <32 weeks' gestational age has a specific predilection for periventricular white matter injury. Early prediction of concomitant motor sequelae is a fundamental clinical issue. Recently, functional MRI was introduced as a noninvasive method for investigating the functional integrity of the neonatal brain. We aimed at implementing a unilateral passive forearm extension/flexion functional MRI paradigm in a routine clinical MRI setup to allow noninvasive mapping of the sensorimotor system in preterm infants and to relate the functional data to structural and behavioral data.

PATIENTS AND METHODS

Eight patients (median gestational age: 26.5 weeks; median birth weight: 885 g) were included. The functional MRI was performed at term-equivalent age (median: 39 weeks' postconceptional age) under chloral hydrate (50 mg/kg) sedation. In 5 of 8 patients, functional MRI data acquisition was successful. This resulted in 10 functional data sets (5 for passive stimulation of each forearm).

RESULTS

Unilateral stimulation was associated with mainly bilateral activation of the primary sensorimotor cortex (n = 7 of 10 data sets), the prevailing hemodynamic response being a negative blood oxygenation level-dependent signal. Positive blood oxygenation level-dependent response or failure to activate the sensorimotor cortex (n = 3 of 10 data sets) were seen in those patients with aberrant structural/behavioral indices.

CONCLUSIONS

Our data show the feasibility of passive unilateral sensorimotor stimulation during neonatal clinical MRI protocols. The bilateral activation pattern observed at this age is compatible with a bilaterally distributed sensorimotor system. Our data validate initial accounts for a raised incidence of negative blood oxygenation level-dependent responses in the primary sensorimotor cortex at this developmental stage. The negative blood oxygenation level-dependent response is likely to reflect a reduction of the oxy/deoxy-hemoglobin ratio during a maturational stage characterized by rapid formation of synapses, yet ineffective processing. Positive blood oxygenation level-dependent responses or failure to activate the sensorimotor cortex may be an early indicator of abnormal development and will have to be followed up carefully.