Symptomatic asymmetry in the first six months of life: differential diagnosis

Asymmetry in infancy is a clinical condition with a wide variation in appearances (shape, posture, and movement), etiology, localization, and severity. The prevalence of an asymmetric positional preference is 12% of all newborns during the first six months of life. The asymmetry is either idiopathic or symptomatic. Pediatricians and physiotherapists have to distinguish symptomatic asymmetry (SA) from idiopathic asymmetry (IA) when examining young infants with a positional preference to determine the prognosis and the intervention strategy. The majority of cases will be idiopathic, but the initial presentation of a positional preference might be a symptom of a more serious underlying disorder. The purpose of this review is to synthesize the current information on the incidence of SA, as well as the possible causes and the accompanying signs that differentiate SA from IA. This review presents an overview of the nine most prevalent disorders in infants in their first six months of life leading to SA. We have discovered that the literature does not provide a comprehensive analysis of the incidence, characteristics, signs, and symptoms of SA. Knowledge of the presented clues is important in the clinical decision making with regard to young infants with asymmetry. We recommend to design a valid and useful screening instrument

Cross-Cultural Validity : Canadian Norm Values of the Alberta Infant Motor Scale Evaluated for Dutch Infants

PURPOSE: To examine whether the Canadian normative values of the Alberta Infant Motor Scale (AIMS) are appropriate for Dutch infants. METHOD: In a cross-sectional study, 499 infants developing typically (0.5-19 months) were assessed using the AIMS home video method. The scaling method was used for calculating item locations of the Dutch sample, and Welch test to compare Canadian and Dutch raw scores. RESULTS: THE: AIMS items (45 of 58) met the criterion for stable regression to calculate item locations of the Dutch data set and compare these with the Canadian data set. Dutch infants passed 42 of 45 items at an older age. Most monthly age groups of Dutch infants had lower mean AIMS scores. CONCLUSION: The Canadian norms are not appropriate for the Dutch study sample. Dutch infants appear to develop in a similar sequence but at a slower rate. This has implications regarding the clinical use of the AIMS in the Netherlands

Nederlandse zuigelingen lopen later los dan Canadese: Is cross-culturele interpretatie van de AIMS verantwoord?

n Nederland wordt de grofmotorische ontwikkeling van zuigelingen van de geboorte tot het loslopen meestal gemeten met de Alberta Infant Motor Scale (AIMS). Dit instrument komt uit Canada. Nederlandse kinderfysiothera-peuten vragen zich al langer af of de Canadese normwaarden van de AIMS wel passend zijn voor Nederlandse zuige-lingen. Deze studie toont aan dat specifieke Nederlandse normwaarden noodzakelijk zijn

Concurrent Validity Between Live and Home Video Observations Using the Alberta Infant Motor Scale

PURPOSE: Serial assessment of gross motor development of infants at risk is an established procedure in neonatal follow-up clinics. Assessments based on home video recordings could be a relevant addition. METHODS: In 48 infants (1.5-19 months), the concurrent validity of 2 applications was examined using the Alberta Infant Motor Scale: (1) a home video made by parents and (2) simultaneous observation on-site by a pediatric physical therapist. Parents' experiences were explored using a questionnaire. RESULTS: The intraclass correlation coefficient agreement between live and home video assessment was 0.99, with a standard error of measurement of 1.41 items. Intra- and interrater reliability: intraclass correlation coefficients were more than 0.99. According to 94% of the parents, recording their infant's movement repertoire was easy to perform. CONCLUSION: Assessing the Alberta Infant Motor Scale based on home video recordings is comparable to assessment by live observation. The video method is a promising application that can be used with low burden for parents and infants

Concurrent Validity Between Live and Home Video Observations Using the Alberta Infant Motor Scale

PURPOSE: Serial assessment of gross motor development of infants at risk is an established procedure in neonatal follow-up clinics. Assessments based on home video recordings could be a relevant addition. METHODS: In 48 infants (1.5-19 months), the concurrent validity of 2 applications was examined using the Alberta Infant Motor Scale: (1) a home video made by parents and (2) simultaneous observation on-site by a pediatric physical therapist. Parents' experiences were explored using a questionnaire. RESULTS: The intraclass correlation coefficient agreement between live and home video assessment was 0.99, with a standard error of measurement of 1.41 items. Intra- and interrater reliability: intraclass correlation coefficients were more than 0.99. According to 94% of the parents, recording their infant's movement repertoire was easy to perform. CONCLUSION: Assessing the Alberta Infant Motor Scale based on home video recordings is comparable to assessment by live observation. The video method is a promising application that can be used with low burden for parents and infants

Cross-Cultural Validity: Canadian Norm Values of the Alberta Infant Motor Scale Evaluated for Dutch Infants

Purpose: To examine whether the Canadian normative values of the Alberta Infant Motor Scale (AIMS) are appropriate for Dutch infants. Method: In a cross-sectional study, 499 infants developing typically (0.5-19 months) were assessed using the AIMS home video method. The scaling method was used for calculating item locations of the Dutch sample, and Welch test to compare Canadian and Dutch raw scores. Results: The AIMS items (45 of 58) met the criterion for stable regression to calculate item locations of the Dutch data set and compare these with the Canadian data set. Dutch infants passed 42 of 45 items at an older age. Most monthly age groups of Dutch infants had lower mean AIMS scores. Conclusion: The Canadian norms are not appropriate for the Dutch study sample. Dutch infants appear to develop in a similar sequence but at a slower rate. This has implications regarding the clinical use of the AIMS in the Netherlands

Factors associated with gross motor development from birth to independent walking: A systematic review of longitudinal research

OBJECTIVE: To gain more insight into child and environmental factors that influence gross motor development (GMD) of healthy infants from birth until reaching the milestone of independent walking, based on longitudinal research. METHODS: A systematic search was conducted using Scopus, PsycINFO, MEDLINE and CINAHL to identify studies from inception to February 2020. Studies that investigated the association between child or environmental factors and infant GMD using longitudinal measurements of infant GMD were eligible. Two independent reviewers extracted key information and assessed risk of bias of the selected studies, using the Quality in Prognostic Studies tool (QUIPS). Strength of evidence (strong, moderate, limited, conflicting, no evidence) for the factors identified was described according to a previously established classification. RESULTS: In 36 studies, six child and 11 environmental factors were identified. Five studies were categorized as having low risk of bias. Strong evidence was found for the association between birthweight and GMD in healthy full-term and preterm infants. Moderate evidence was found for associations between gestational age and GMD, and sleeping position and GMD. There was conflicting evidence for associations between twinning and GMD, and breastfeeding and GMD. No evidence was found for an association between maternal postpartum depression and GMD. Evidence for the association of other factors with GMD was classified as 'limited' because each of these factors was examined in only one longitudinal study. CONCLUSION: Infant GMD appears associated with two child factors (birthweight, gestational age), and one environmental factor (sleeping position). For the other factors identified in this review, insufficient evidence for an association with GMD was found. For those factors that were examined in only one longitudinal study, and are therefore classified as having limited evidence, more research would be needed to reach a conclusion

Factors associated with gross motor development from birth to independent walking: A systematic review of longitudinal research

OBJECTIVE: To gain more insight into child and environmental factors that influence gross motor development (GMD) of healthy infants from birth until reaching the milestone of independent walking, based on longitudinal research. METHODS: A systematic search was conducted using Scopus, PsycINFO, MEDLINE and CINAHL to identify studies from inception to February 2020. Studies that investigated the association between child or environmental factors and infant GMD using longitudinal measurements of infant GMD were eligible. Two independent reviewers extracted key information and assessed risk of bias of the selected studies, using the Quality in Prognostic Studies tool (QUIPS). Strength of evidence (strong, moderate, limited, conflicting, no evidence) for the factors identified was described according to a previously established classification. RESULTS: In 36 studies, six child and 11 environmental factors were identified. Five studies were categorized as having low risk of bias. Strong evidence was found for the association between birthweight and GMD in healthy full-term and preterm infants. Moderate evidence was found for associations between gestational age and GMD, and sleeping position and GMD. There was conflicting evidence for associations between twinning and GMD, and breastfeeding and GMD. No evidence was found for an association between maternal postpartum depression and GMD. Evidence for the association of other factors with GMD was classified as 'limited' because each of these factors was examined in only one longitudinal study. CONCLUSION: Infant GMD appears associated with two child factors (birthweight, gestational age), and one environmental factor (sleeping position). For the other factors identified in this review, insufficient evidence for an association with GMD was found. For those factors that were examined in only one longitudinal study, and are therefore classified as having limited evidence, more research would be needed to reach a conclusion

A home-video method to assess infant gross motor development: parent perspectives on feasibility

Background: Current use of smartphone cameras by parents create opportunities for longitudinal home-video-assessments to monitor infant development. We developed and validated a home-video method for parents, enabling Pediatric Physical Therapists to assess infants’ gross motor development with the Alberta Infant Motor Scale (AIMS). The objective of the present study was to investigate the feasibility of this home-video method from the parents’ perspective. Methods: Parents of 59 typically developing infants (0–19 months) were recruited, 45 parents participated in the study. Information about dropout was collected. A sequential mixed methods design was used to examine feasibility, including questionnaires and semi-structured interviews. While the questionnaires inquired after the practical feasibility of the home-video method, the interviews also allowed parents to comment on their feelings and thoughts using the home-video method. Results: Of 45 participating parents, 34 parents returned both questionnaires and eight parents agreed to an interview. Parent reported effort by the infants was very low: the home-video method is perceived as similar to the normal routine of playing. The parental effort level was acceptable. The main constraint parents reported was time planning. Parents noted it was sometimes difficult to find the right moment to record the infant’s motor behavior, that is, when parents were both at home and their baby was in the appropriate state. Technical problems with the web portal, reported by 28% of the parents were also experienced as a constraint. Positive factors mentioned by parents were: the belief that the home videos are valuable for family use, receiving feedback from a professional, the moments of one-on-one attention and interaction with their babies. Moreover, the process of recording the home videos resulted in an increased parental awareness of, and insight into, the gross motor development of their infant. Conclusion: The AIMS home-video method is feasible for parents of typically developing children. Most constraints are of a practical nature that can be addressed in future applications. Future research is needed to show whether the home-video method is also applicable for parents with an infant at risk of motor development problems

Modeling a gross motor curve of typically developing Dutch infants from 3.5 to 15.5 months based on the Alberta Infant Motor Scale

Background: Interindividual variability in gross motor development of infants is substantial and challenges the interpretation of motor assessments. Longitudinal research can provide insight into variability in individual gross motor trajectories. Purpose: To model a gross motor growth curve of healthy term-born infants from 3.5 to 15.5 months with the Alberta Infant Motor Scale (AIMS) and to explore groups of infants with different patterns of development. Methods: A prospective longitudinal study including six assessments with the AIMS. A Linear Mixed Model analysis (LMM) was applied to model motor growth, controlled for covariates. Cluster analysis was used to explore groups with different pathways. Growth curves for the subgroups were modelled and differences in the covariates between the groups were described and tested. Results: In total, data of 103 infants was included in the LMM which showed that a cubic function (F(1,571) = 89.68, p < 0.001) fitted the data best. None of the covariates remained in the model. Cluster analysis delineated three clinically relevant groups: 1) Early developers (32%), 2) Gradual developers (46%), and 3) Late bloomers (22%). Significant differences in covariates between the groups were found for birth order, maternal education and maternal employment. Conclusion: The current study contributes to knowledge about gross motor trajectories of healthy term born infants. Cluster analysis identified three groups with different gross motor trajectories. The motor growth curve provides a starting point for future research on motor trajectories of infants at risk and can contribute to accurate screening