Neuromotor development in children. Part 3: motor performance in 3- to 5-year-olds.

AIM: The aim of this cross-sectional study was to provide normative data (ordinal scores and timed performances) for gross and fine motor tasks in typically developing children between 3 and 5 years of age using the Zurich Neuromotor Assessment (ZNA). METHOD: Typically developing children (n=101; 48 males, 53 females) between 3 and 5 years of age were enrolled from day-care centres in the greater Zurich area and tested using a modified version of the ZNA; the tests were recorded digitally on video. Intraobserver reliability was assessed on the videos of 20 children by one examiner. Interobserver reliability was assessed by two examiners. Test-retest reliability was performed on an additional 20 children. The modelling approach summarized the data with a linear age effect and an additive term for sex, while incorporating informative missing data in the normative values. Normative data for adaptive motor tasks, pure motor tasks, and static and dynamic balance were calculated with centile curves (for timed performance) and expected ordinal scores (for ordinal scales). RESULTS: Interobserver, intraobserver, and test-retest reliability of tasks were moderate to good. Nearly all tasks showed significant age effects, whereas sex was significant only for stringing beads and hopping on one leg. INTERPRETATION: These results indicate that timed performance and ordinal scales of neuromotor tasks can be reliably measured in preschool children and are characterized by developmental change and high interindividual variability

Correlation between motor performance and cognitive functions in children born <1250g at school age

Very low birth weight born children manifest a higher prevalence of motor and cognitive impairments than term children. Seventy-four prospectively enrolled children born <1250 g underwent testing of motor (Zurich neuromotor assessment ZNA: timed motor performances and associated movements) and cognitive functions (Kaufman-ABC) at age six years. Children with cerebral palsy or mental retardation were excluded. Adaptive motor tasks (pegboard and dynamic balance) and visuomotor cognitive functions were specifically impaired, and a distinct correlation pattern between motor and cognitive abilities was detected. The adaptive fine motor task (pegboard) correlated with visuomotor functions of the Kaufman-ABC ("triangles", r = 0.35; "matrix analogies", r = 0.39), while pure motor tasks of the ZNA (repetitive, alternating, and sequential movements) did not in spite of impaired motor performance. Timed motor performance below the 10th percentile correlated strongly with cognitive delay (IQ <85: adaptive fine motor: OR 6.0 [95% CI] 4.7-7.3; adaptive gross motor: OR 7.0 [CI 5.6-8.4]; static balance: OR 9.6 [CI 8.2-11.0]). In conclusion, motor deficits in children born <1250 g without severe disabilities correlate with specific cognitive impairments, in particular of the visuomotor domain. The correlation pattern may indicate specific dysfunction in visuomotor transformation, the intermediate process between visual-perceptual input and motor output. Early assessment of both motor and cognitive functions using standardized assessment tools is important to determine the extent and combination of specific developmental disturbances and to tailor therapeutic intervention

A quick and qualitative assessment of gross motor development in preschool children.

There is a need for a quick, qualitative, reliable, and easy tool to assess gross motor development for practitioners. The aim of this cross-sectional study is to present the Zurich Neuromotor Assessment-Q (ZNA-Q), which assesses static and dynamic balance in children between 3 and 6 years of age in less than 5 min. A total of 216 children (103 boys; 113 girls; median age 4 years, 4 months; interquartile range 1 year, 3 months) were enrolled from day-care centers, kindergartens, and schools, and were tested with 5 different gross motor tasks: standing on one leg, tandem stance, hopping on one leg, walking on a straight line, and jumping sideways. All ordinal measures (consisting of qualitative measures and scales) featured a marked developmental trend and substantial inter-individual variability. Test-retest reliability was assessed on 37 children. It varied from .17 for tandem stance to .43 for jumping sideways for the individual tasks, and it was .41 and .67 for the static and dynamic balance components, respectively. For the whole ZNA-Q, test-retest reliability was .7.Conclusion: Ordinal scales enable practitioners to gather data on children's gross motor development in a fast and uncomplicated way. It offers the practitioner with an instrument for the exploration of the current developmental motor status of the child. What is Known: • Measurement of gross motor skills in the transitional period between motor mile stones and quantitative assessments is difficult. • Assessment of gross motor skills is relatively easy. What is New: • Supplementary and quick gross motor test battery for children for practitioners. • Normative values of five gross motor skills measured with ordinal scales

Similarities and dissimilarities between the Movement ABC-2 and the Zurich Neuromotor Assessment in children with suspected developmental coordination disorder.

An established tool for the assessment of motor performance in children with developmental coordination disorder (DCD) is the Movement-ABC-2 (M-ABC-2). The Zurich Neuromotor Assessment (ZNA) is also widely used for the evaluation of children's motor performance, but has not been compared with the M-ABC-2. Fifty-one children (39 males) between 5 and 7 years of age with suspected DCD were assessed using the M-ABC-2 and the ZNA. Rank correlations between scores of different test components were calculated. The structure of the tests was explored using canonical-correlation analysis. The correlation between total scores of the two motor tests was reasonable (0.66; p&lt;0.001). However, ZNA scores were generally lower than those of M-ABC-2, due to poor performance in the fine motor adaptive component and increased contralateral associated movements (CAM). The canonical-correlation analysis revealed that ZNA measures components like pure motor skills and CAM that are not represented in the M-ABC-2. Furthermore, there was also no equivalent for the aiming and catching items of the M-ABC-2 in ZNA. The two tests measure different motor characteristics in children with suspected DCD and, thus, can be used complementary for the diagnosis of the disorder

Neuromotor development in children. Part 4: new norms from 3 to 18 years.

The aim of this cross-sectional study was to provide normative data for motor proficiency (motor performance and contralateral associated movements [CAMs]) in typically developing children between 3 years and 18 years of age using an updated version of the Zurich Neuromotor Assessment (ZNA-2). Six-hundred and sixteen typically developing children between 3 years and 18 years of age were enrolled from day-care centres, kindergartens, and schools, and were tested using the ZNA-2 with improved items of the original battery. Motor proficiency was assessed on five components (fine motor tasks, pure motor tasks, static balance, dynamic balance, and CAMs) as a function of age and sex to determine centile curves for each task. Intraobserver, interobserver, and test-retest reliabilities were evaluated. Most ZNA-2 tasks featured a marked developmental trend and substantial interindividual variability. Test-retest reliability was generally high (e.g. static balance 0.67; CAMs 0.81; and total scores 0.84). The ZNA-2 is a reliable and updated test instrument to measure motor proficiency in children from 3 to 18 years with improved properties for assessing motor performance. It allows continuous measurement without changing items for the entire age range; this feature of the ZNA-2 is unique and makes the instrument suitable for clinical purposes. The reduction of CAMs scoring simplifies the clinical procedure and increases its reliability. The Zurich Neuromotor Assessment, Second Edition (ZNA-2) provides new norms for motor proficiency in children between 3 years and 18 years. High reliabilities suggest that the revised test battery is a useful tool for assessing neuromotor development. Integration of a 'not able to perform' category makes the ZNA-2 suitable for clinical purposes

MRI following severe perinatal asphyxia: preliminary experience.

In 30 children suffering from severe perinatal asphyxia an attempt was made to determine the early prognostic signs of severe hypoxic-ischemic brain injury with magnetic resonance imaging (MRI). Ten early (1-4 days of age), 16 intermediate (2-4 weeks of age), and 38 late MRI (older than 1 month of age) procedures were performed on a 2.35 T MR-system. Severe cerebral necrosis was suspected by T2 hyperintensity of the white matter, with blurred limits to the cortex in early MRI, and was confirmed by T1 hyperintensity of the cortex in intermediate MRI. Severe cerebral necrosis was established at 3 months of age. Of the 11 children with this pattern (group A), 8 had severe and 3 had moderate cerebral palsy on subsequent examination. Thirteen children (group B) had normal late MRI scans; none developed severe cerebral palsy or marked mental retardation. Two children (group C) had focal ischemic lesions. Four children had intracranial hemorrhage (group D). Groups A and B did not differ in the severity of their perinatal histories and findings, suggesting that MRI during the first 3 months is of significant prognostic value

Prognostic value of early MR imaging in term infants with severe perinatal asphyxia.

The prognostic significance of magnetic resonance imaging (MRI) in the neonatal period was studied prospectively in 43 term infants with perinatal asphyxia. MRI was performed between 1 and 14 days after birth with a high field system (2.35 Tesla). Neurodevelopmental outcome was assessed by a standardized neurological examination and the Griffiths developmental test at a mean age of 18.9 months. The predictive value of the various MRI patterns was as follows: Severe diffuse brain injury (pattern AII+III; n = 7) and lesions of thalamus and basal ganglia (pattern C; n = 5) were strongly associated with poor outcome and greatly reduced head growth. Mild diffuse brain injury (pattern AI; n = 7), parasagittal lesions (B; n = 7), periventricular hyperintensity (D; n = 2), focal brain necrosis and hemorrhage (E; n = 3) and periventricular hypointense stripes (on T2-weighted images; F; n = 3) led in one third of the infants to minor neurological disturbances and mild developmental delay. Infants with normal MRI findings (G; n = 9) developed normally with the exception of one infant who was mildly delayed at 18 months. The results indicate that MRI examination during the first two weeks of life is of prognostic significance in term infants suffering from perinatal asphyxia. Severe hypoxic-ischemic brain lesions were associated highly significantly with poor neuro-developmental outcome, whereas infants with inconspicuous MRI developed normally