The neuromotor examination of the preschool child and its prognostic significance.

The present paper reviews the methods available for neurological or neuromotor evaluation at preschool age. General textbooks on pediatric neurology describe the neurological examination at preschool age in terms of the assessment of the evaluation of cranial nerves, muscle tone, muscle power, reflexes, and the presence of abnormal movements. They stress the fact that assessment at preschool age is difficult because of the time needed to achieve the child's cooperation.

Kinematic characteristics of postural control during reaching in preterm children with cerebral palsy.

The relationships between kinematic characteristics of sitting posture during reaching movements of the dominant arm and 1) the kinematics of the reaching movement itself and 2) functional performance during daily life activities (PEDI) were assessed in 51 sitting preterm children with cerebral palsy (CP). The children were 2-11 y, 33 had spastic hemiplegia (SH) and 18 bilateral CP (Bi-CP). The data were compared with those of 26 typically developing children (TD).

The role of long-chain polyunsaturated fatty acids (LCPUFA) in growth and development.

It is debatable whether supplementation of infant formula with LCPUFA has an effect on infant growth and development. Up till now, there is little evidence of a negative effect on infant growth. A review of randomized controlled trials in term infants revealed that LCPUFA, in particularly supplementation with > or = 0.

Postural dysfunction in children with cerebral palsy: some implications for therapeutic guidance.

Postural problems play a central role in the motor dysfunction of children with cerebral palsy (CP). Therefore, they spend more time in sitting than in standing to perform vital tasks of daily life. The focus of this article is to describe the pathophysiology of postural control in sitting and outline some implications for management and treatment.

Postural muscle dyscoordination in children with cerebral palsy.

The present paper gives an overview of the knowledge currently available on muscular dyscoordination underlying postural problems in children with cerebral palsy (CP). Such information is a prerequisite for developing successful therapeutic interventions in children with CP. Until now, three children with CP functioning at GMFCS (Gross Motor Function Classification System) level V have been documented.

Postural behavior in children born preterm.

The present paper presents clinical and neurophysiological data of postural behavior in preterm children without CP. Clinical follow-up studies of preterm infants until toddler and school age have reported that low-risk preterm infants may have atypical postural behavior in terms of reduced amount of rotation during crawling, delayed dynamic balance, delayed onset of and a poor quality of early walking behavior. At school age, dysfunctions such as problems in standing on one leg and poor hopping are reported.

Development of postural control during the first 18 months of life.

The present paper reviews the development of postural adjustments during infancy. In the control of posture, two functional levels can be distinguished. The basic level deals with the generation of direction-specific adjustments, meaning that dorsal muscles are primarily activated when the body sways forward, whereas ventral muscles are primarily activated when the body sways backward.

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.

Impaired maternal glucose homeostasis during pregnancy is associated with low status of long-chain polyunsaturated fatty acids (LCP) and essential fatty acids (EFA) in the fetus.

Low status of long-chain polyunsaturated fatty acids (LCP) and essential fatty acids (EFA) in the fetus is associated with less favorable neonatal neurological condition. A 'relative', rather than 'absolute' EFA deficiency might explain this finding. A relative EFA deficiency may derive from impaired maternal glucose homeostasis.

Acid-base status at birth, spontaneous motor behaviour at term and 3 months and neurodevelopmental outcome at age 4 years in full-term infants.

Objective: The aim of the study was to assess the relationship between acid-base status and quality and quantity of General Movements (GMs) at birth and quality of GMs at age 3 months and motor, cognitive and behavioural functioning at the age of 4 years.

Methods: From a cohort of 84 term children with different umbilical artery pH without severe neonatal neurological abnormalities, GMs were assessed at term and at 3 months. At the age of 4 years, 44 children were assessed by means of the Movement Assessment Battery for Children (Movement-ABC), Neurological Examination for Toddlers of Hempel, Kaufman Assessment Battery for Children information processing (Kaufman ABC), Visuomotor Integration (VMI), the Child Behaviour Checklist (CBCL) and Precursors ADHD Questionnaire (PAQ).

A systematic review of the effects of early intervention on motor development.

We present a systematic review on the effect of early intervention, starting between birth and a corrected age of 18 months, on motor development in infants at high risk for, or with, developmental motor disorders. Thirty-four studies fulfilled the selection criteria. Seventeen studies were performed within the neonatal intensive care unit (NICU) environment.

Development of postural adjustments in sitting position during the first half year of life.

Little is known about the development of postural adjustments during early ontogeny. We examined postural adjustments due to sudden perturbations during sitting in 40 healthy term infants (28 males, 12 females) assessed in groups of eight at 1, 2, 3, 4, and 5 months of age. Surface electromyograms of neck, trunk, and leg muscles were recorded while the infants were exposed to a random series of horizontal forward and backward displacements of the surface of support.

Long-chain polyunsaturated fatty acids and neurological developmental outcome at 18 months in healthy term infants.

Aim: Previously, we found a beneficial effect of 2 mo supplementation of infant formula with long-chain polyunsaturated fatty acids (LC-PUFA) on neurological condition at 3 mo in healthy term infants. The aim of the present follow-up study was to evaluate whether the effect on neurological condition persists until 18 mo.

Methods: A prospective, double-blind, randomized control study was conducted.

Kinematic characteristics of reaching movements in preterm children with cerebral palsy.

Kinematic characteristics of reaching movements of the dominant arm were assessed in 51 sitting preterm children who were aged 2-11 y and had cerebral palsy (CP), including 33 with spastic hemiplegia and 18 with bilateral CP (Bi-CP). Reference data of 29 typically developing children were present. The results indicated that the quality of reaching movements from the dominant arm of children with CP was significantly worse than that of typically developing children.

Lower fetal status of docosahexaenoic acid, arachidonic acid and essential fatty acids is associated with less favorable neonatal neurological condition.

Long-chain polyunsaturated fatty acids, notably arachidonic (AA) and docosahexaenoic (DHA) acids are abundant in brain and may be conditionally essential in fetal life. We investigated umbilical artery (UA) and vein (UV) fatty acid compositions and early neonatal neurological condition in 317 term infants. Neurological condition was summarized as a clinical classification and a 'neurological optimality score' (NOS).

Obstetric optimality and emotional problems and substance use in young adulthood.

Background: Pregnancy and delivery are complex processes, and isolated obstetric complications rare and often accompanied or followed by a number of others.

Aims: To study the relationship between the overall obstetric situation (as opposed to single obstetric risk factors) and emotional and substance use disorders in young adulthood, and to analyse whether these links are mediated by temperaments in childhood.

Study Design: In a prospective birth cohort (n=3162), questionnaires were sent to mothers and teachers when the child was 7-10 years old, and to the children when they were 20-25 years old.

General movements: A window for early identification of children at high risk for developmental disorders.

Detection of children with a developmental disorder, such as cerebral palsy, at an early age is notoriously difficult. Recently, a new form of neuromotor assessment of young infants was developed, based on the assessment of the quality of general movements (GMs). GMs are movements of the fetus and young infant in which all parts of the body participate.

Quality of general movements and the development of minor neurological dysfunction at toddler and school age.

Objective: To evaluate the reliability of assessing infants' general movements (GMs) using a new classification and its validity in predicting complex minor neurological dysfunction (MND) at toddler and at school age.

Design: Prospective study of two groups of infants, each consisting of a mix of low-risk and high-risk infants.

Setting: University Hospital Groningen, the Netherlands.

Postural control during reaching in preterm children with cerebral palsy.

Postural control during reaching with the dominant arm was assessed in 58 preterm children with cerebral palsy (CP) aged 2 to 11 years, comprising 34 with spastic hemiplegia (17 males, 17 females) and 24 with bilateral spastic CP (bilateral CP; 15 male, 9 females). Assessments were made by multiple surface electromyogram (EMG) and kinematic recording. Mean gestational age at birth for the children with spastic hemiplegia and those with bilateral CP was 28.

Postural adjustments due to external perturbations during sitting in 1-month-old infants: evidence for the innate origin of direction specificity.

The aim of the study was to examine whether infants, at an age when they have no or little experience in sitting, can produce direction specific postural adjustments, i.e. synergies of muscle activity on the ventral side of the body during backward sway and on the dorsal side during forward sway.

Exclusive breastfeeding of healthy term infants for at least 6 weeks improves neurological condition.

To investigate the minimal duration of exclusive breastfeeding for optimal neurological outcome, we assessed the quality of general movements (GM) at 3 mo of 147 breastfed healthy term infants that were followed from birth. The quality of GM is a sensitive marker of neurological condition. The quality of GM was classified as normal-optimal, normal-suboptimal, mildly abnormal and definitely abnormal.

Is hypotension a major risk factor for neurological morbidity at term age in very preterm infants?

Objective: To investigate the influence of perinatal risk factors, especially hypotension, on neuromotor status at term in surviving preterm infants born before 32 weeks of gestation.

Methods: This study is part of the Leiden Follow-Up Project on Prematurity: a prospective, regional study of 266 live born infants with a gestational age (GA) < 32 weeks born in 1996-1997. Twenty-eight infants died before term age.