Evaluation of Motor Function in Young Infants by Means of the Assessment of General Movements:A Review

Purpose: Optimal management of children with developmental disorders, such as cerebral palsy (CP), requires detection at an early age. The purpose of this paper is to review the predictive value of various forms of traditional neonatal neurological examination and that of a new form of neuromotor assessment of young infants, based on the assessment of the quality of general movements (GMs).Summary of Key Points: The technique of GM assessment is presented and the features of normal, mildly abnormal and definitely abnormal GMs discussed. Essential to GM assessment is the Gestalt evaluation of movement complexity and variation. The quality of GMs at two to four months postterm has been found to have the highest predictive value. The presence of definitely abnormal GMs at this age, ie, GMs devoid of complexity and variation, puts a child at very high risk for CP.Conclusions: This implies that definitely abnormal GMs at two to four months are an indication for early physical therapy intervention.</p

Developmental Coordination Disorder: Is Clumsy Motor Behavior Caused by a Lesion of the Brain at Early Age?

Children presenting with Developmental Coordination Disorder or clumsiness often exhibit signs of minor neurological dysfunction (MND). The data of the Groningen Perinatal Project, a long-term follow-up project .on the relations between prenatal and perinatal adversities and neurological, behavioral, and cognitive development revealed that two basic forms of MND can be distinguished: simple and complex MND. During school age children with simple MND are characterized by the presence of one or two dysfunctional clusters of MND, in adolescence by the presence of choreiform dyskinesia or hypotonia. Probably the major sources of origin of simple MND are genetic constitution and stress during early life. Simple MND might reflect the lower tail of the normal distribution of the quality of non-pathological brain function. In line with this hypothesis is the finding that simple MND is associated with only a moderately increased risk for learning and behavioral problems. Children with complex MND present at school age with at least three dysfunctional clusters of MND, in adolescence with problems in fine manipulation or coordination. Perinatal adversities play an evident etiological role in the development of complex MND, suggesting that it might be attributed to a lesion of the brain at early age. In line with this idea is the finding that complex MND shows .a strong correlation with attention and learning problems

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. The second level is involved in adaptation of the direction-specific adjustments. Postural development starts with a repertoire of direction-specific adjustments suggesting that the basic level of control has an innate origin. At first, during the phase of primary variability, postural activity is largely variable and can be minimally adapted to environmental constraints. At 3 months, postural activity shows a transient period during which few postural muscles participate in postural activity. From 6 months onward, the phase of secondary variability starts, during which the second level of postural control becomes functionally active and infants develop the ability to adapt postural activity to the specifics of the situation. Initially, adaptation can be accomplished in a simple way only, but from 9–10 months onward, it can be performed by the subtle adaptation of the degree of muscle contraction. Around 13–14 months, anticipatory postural adjustments emerge. It is concluded that the development of postural adjustments is characterized by four periods of transition occurring at the ages of 3, 6, 9-10, and 13-14 months. The major transition occurs at 6 months, when infants move from the phase of non-adaptive, primary variability to the phase of adaptive, secondary variability