Study of symptomatic birth asphyxia : its immediate manifestations and long term significance

Despite improvement in healthcare during pregnancy and childbirth, intrapartum asphyxia remains a substantial problem. Mild degrees are common, producing signs of fetal distress during labour and temporary depression of vital function at birth, but, in the absence of neonatal sequelae, are generally benign without longer term implications. More severe degrees of intrapartum asphyxia may be followed by disturbances of function in many body systems, most notably the central nervous system; a situation referred to as symptomatic birth asphyxia. Although such disturbances are often transient, there is a risk of permanent neurological handicap in some cases. Acute, neonatal, neurological consequences of intrapartum asphyxia have long \s been recognised, but,in the literature, differences remain of the detailed neurological findings described, of the interpretation of their immediate significance and of the prognostic significance attributed to such neonatal findings. To look at these aspects, a prospective study of symptomatic birth asphyxia has been conducted. Fifty, mainly mature, infants were identified in the early hours of life by their fulfillment of preselected criteria of symptomatic birth asphyxia. Their general characteristics, antenatal and intrapartum factors, birth condition and the abnormalities of performance and behaviour which the infants displayed are reported. The infants'status over the early neonatal period, carefully assessed by repeated neurological examinations, appropriate investigation, and physiological recording of electroencephalograph, polygraph, and sucking and respiratory patterns, is described and illustrated. The majority of the children have been the subject of regular assessments to primary school age to determine their outcome. Three infants died in the first days of life and a fourth, who was severely brain damaged, in later infancy. Five children have significant handicap, seven mild degrees of neurological or developmental abnormality, while the remaining thirty-four children are considered normal. A number of neonatal events and findings correlated well with outcome. Indicators of condition at birth, the occurrence of apnoeic episodes, prolonged gasping respirations, a phase of apathy, tonic seizures, prolonged depression of feeding reflexes, hypothermia, and certain patterns of neurological abnormality - persistent hypotonia, marked extensor hypertonus with preceding and succeeding hypotonic phases, bulbar palsy and ophthalmo¬ plegia, all bore a highly significant relationship to poor outcome. Of these, the abnormalities of muscle tone and ophthalmoplegia correlated strongly with outcome; the consideration of additional, significant risk factors did not add to their predictive value

Cerebral Palsy

Nowadays, cerebral palsy (CP) rehabilitation, along with medical and surgical interventions in children with CP, leads to better motor and postural control and can ensure ambulation and functional independence. In achieving these improvements, many modern practices may be used, such as comprehensive multidisciplinary assessment, clinical decision making, multilevel surgery, botulinum toxin applications, robotic ambulation applications, treadmill, and other walking aids to increase the quality and endurance of walking. Trainings are based on neurodevelopmental therapy, muscle training and strength applications, adaptive equipment and orthotics, communication, technological solves, and many others beyond the scope of this book. In the years of clinical and academic experiences, children with cerebral palsy have shown us that the world needs a book to give clinical knowledge to health professionals regarding these important issue. This book is an attempt to fulfill and to give “current steps” about CP. The book is intended for use by physicians, therapists, and allied health professionals who treat/rehabilitate children with CP. We focus on the recent concepts in the treatment of body and structure problems and describe the associated disability, providing suggestions for further reading. All authors presented the most frequently used and accepted treatment methods with scientifically proven efficacy and included references at the end of each chapter

Feeding behaviour in term and preterm infants

Recent advances in technology have resulted in more preterm infants being kept alive. These increases in survival rates have, however, been met with a parallel increase in morbidity rates. My thesis has been concerned with monitoring the feeding behaviour of preterm infants born at a low gestation and birthweight, who are at risk of developing neurological problems. These infants often have difficulty co-ordinating the different mechanisms of feeding, namely sucking, swallowing and breathing. Particular attention was paid to sucking, viewing it as a precocious motor skill. By using a new dimension of the tau theory of motor control, namely the intrinsic tau-pacemaker model, normal sucking control was established by examining the intra oral sucking pressures of twelve term newborns The results supported a strong coupling between the tau of the pressure generated inside the mouth and an intrinsic tau-pacemaker. Six preterm infants born at less than 30 weeks gestational age and classified as neurologically at risk, were also tested from when they started bottle feeding, and for a period of four weeks thereafter. Their sucking pressures were analysed in the same way, and were individually compared to the standard set by the newborn terms. Large deviations from term norms were hypothesised to be indicative of neurological abnormalities. Irregularities in sucking control were found, but as expected, the extent of the variation differed between infants. Follow up movement assessments, when four of the infants were greater than six months corrected age, were performed by a physiotherapist. The physiotherapist's assessment of motor development at this stage appeared to reflect the findings obtained for the infants' sucking control. Breathing measurements were also recorded, and modulations in the pattern during feeding were noted. Again a newborn term pattern was established, and preterm infants were compared. As before, all the preterm infants tested had differing degrees of respiratory difficulty. Breathing problems were evident from significantly lower levels of oxygen concentration in the blood, and a significant difference in the timing and depth of the breaths during the sucking and pause periods of feeding. In conclusion an analysis of feeding behaviour appears to present a wealth of information about the neurological and physiological development of very preterm infants. vi

Case Study of Physiotherapy Treatment of a Patient with Bilateral Achilles Tendon Prolongation after Spastic Biparesis of Neuroinfectious Aetiology

FyzioterapieFaculty of Physical Education and SportFakulta tělesné výchovy a sport

Non Invasive Tools for Early Detection of Autism Spectrum Disorders

Autism Spectrum Disorders (ASDs) describe a set of neurodevelopmental disorders. ASD represents a significant public health problem. Currently, ASDs are not diagnosed before the 2nd year of life but an early identification of ASDs would be crucial as interventions are much more effective than specific therapies starting in later childhood. To this aim, cheap an contact-less automatic approaches recently aroused great clinical interest. Among them, the cry and the movements of the newborn, both involving the central nervous system, are proposed as possible indicators of neurological disorders. This PhD work is a first step towards solving this challenging problem. An integrated system is presented enabling the recording of audio (crying) and video (movements) data of the newborn, their automatic analysis with innovative techniques for the extraction of clinically relevant parameters and their classification with data mining techniques. New robust algorithms were developed for the selection of the voiced parts of the cry signal, the estimation of acoustic parameters based on the wavelet transform and the analysis of the infant’s general movements (GMs) through a new body model for segmentation and 2D reconstruction. In addition to a thorough literature review this thesis presents the state of the art on these topics that shows that no studies exist concerning normative ranges for newborn infant cry in the first 6 months of life nor the correlation between cry and movements. Through the new automatic methods a population of control infants (“low-risk”, LR) was compared to a group of “high-risk” (HR) infants, i.e. siblings of children already diagnosed with ASD. A subset of LR infants clinically diagnosed as newborns with Typical Development (TD) and one affected by ASD were compared. The results show that the selected acoustic parameters allow good differentiation between the two groups. This result provides new perspectives both diagnostic and therapeutic

Neurodevelopmental Outcomes Following Severe Hand Foot and Mouth Disease in Vietnam

In 2011, more than 160 children died in an unprecedented outbreak of Hand foot and mouth disease (HFMD) in Vietnam, predominantly associated with enterovirus 71 (EV-A71). The occurrence of encephalitis outbreaks in children at vulnerable developmental stages raised concerns of long-term consequences. Limited retrospective outcome studies in the literature lack either a healthy comparison group or a locally validated neurodevelopmental assessment tool. Brain MRI retrospective observations identified stereotypical patterns of brainstem lesions predominantly in severe EV-A71 HFMD cases with conflicting opinions on the prognostic role of MRI. I adapted the “Bayley Scales of Infant and Toddler Development (3rd edition)” for Vietnam and demonstrated that the adaptation was reliable and valid. I conducted a prospective observational cohort study to test the hypothesis that children with severe HFMD, graded per Vietnam Ministry of Health classification, would have lower cognitive, language and motor Z scores than a healthy comparison group. All HFMD cases had virological samples taken and a sample of severe HFMD cases had brain MRI scans. All Z score 95% confidence intervals were within 2 standard deviations of the comparative healthy cohort mean suggesting outcomes at six months were not significantly lower than the healthy comparative group. I identified novel nonspecific brain white matter abnormalities on MRI in all severity grades, lower motor Z scores in grade 2b children with MRI abnormalities and that Coxsackievirus A10 (CV-A10) was significantly associated with MRI abnormalities. These findings support surveillance of all enteroviruses during HFMD outbreaks and suggest MRI may be predictive of motor impairment in a subset of severe HFMD cases. No significant impairment was identified at six months follow-up, but more complex developmental skills are yet to emerge. Hence the study continues for an eighteen-month follow up to robustly determine emergence of long-term sequelae