A Comparison of the Leg Coordination Patterns of Preterm and Fullterm Infants: A Meta-Analysis

Background and Purposes: The purposes of this meta-analysis were (1) to investigate the relation between prematurity and the parameters of infant kicking, and (2) to examine to what degree the effect size varies as a function of age, study type, publication type, and country of origin. Methods: Six studies met all the inclusion criteria and were used for this meta-analysis. A r-indicator was used to represent the effect size indicating the difference between low-risk preterm and full term infants and the difference in kinematic variables between high-risk preterm and full term infants. A fixed-effect model was assumed in this study. To determine whether the r-indicators were derived from a common population, a heterogeneity analysis (Q) was computed for each kinematic variable. Potential moderators (study type, publication type, country of origin, and age) were analyzed for each variable. Results: Overall, there was a consistent moderate to large effect size for intralimb coordination variables between high-risk preterm and full term infants. For other kicking parameters, there was a small effect size between preterm infants (both low-risk and high­ risk groups) and full term infants. From the moderator analyses, studies testing high-risk infants younger than 4 months had a small positive effect for the measures of intralimb coordination, the hip-knee and hip-ankle joint correlations; whereas studies testing infants older than 4 months had a large positive effect on these hip-knee and hip-ankle pairs. On the contrary, studies testing low-risk infants younger than 4 months had a medium positive effect; whereas studies testing low-risk infants older than 4 months showed no effect. Conclusion: The results suggest that intralimb coordination parameters after 4 months of age may be early indicators of atypical coordination since low-risk infants resolved their differences after 4 months of age but high-risk infants sustained the atypical intralimb coordination

Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy International Clinical Practice Guideline Based on Systematic Reviews:International Clinical Practice Guideline Based on Systematic Reviews

IMPORTANCE: Cerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years. OBJECTIVE: To systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support. EVIDENCE REVIEW: The literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument. FINDINGS: Sixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5). CONCLUSIONS AND RELEVANCE: When a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline

Patient-, organization-, and system-level barriers and facilitators to preventive oral health care:A convergent mixed-methods study in primary dental care

Background: Dental caries is the most common chronic disease of adult and childhood, a largely preventable yet widespread, costly public health problem. This study identified patient-, organization-, and system-level factors influencing routine delivery of recommended care for prevention and management of caries in primary dental care. Methods: A convergent mixed-methods design assessed six guidance-recommended behaviours to prevent and manage caries (recording risk, risk-based recall intervals, applying fluoride varnish, placing preventive fissure sealants, demonstrating oral health maintenance, taking dental x-rays). A diagnostic questionnaire assessing current practice, beliefs, and practice characteristics was sent to a random sample of 651 dentists in National Health Service (NHS) Scotland. Eight in-depth case studies comprising observation of routine dental visits and dental team member interviews were conducted. Patient feedback was collected from adult patients with recent checkups at case study practices. Key informant interviews were conducted with decision makers in policy, funding, education, and regulation. The Theoretical Domains Framework within the Behaviour Change Wheel was used to identify and describe patient-, organization-, and system-level barriers and facilitators to care. Findings were merged into a matrix describing theoretical domains salient to each behaviour. The matrix and Behaviour Change Wheel were used to prioritize behaviours for change and plan relevant intervention strategies. Results: Theoretical domains associated with best practice were identified from the questionnaire (N-196), case studies (N = 8 practices, 29 interviews), and patient feedback (N = 19). Using the study matrix, key stakeholders identified priority behaviours (use of preventive fissure sealants among 6–12-year-olds) and strategies (audit and feedback, patient informational campaign) to improve guidance implementation. Proposed strategies were assessed as appropriate for immediate implementation and suitable for development with remaining behaviours. Conclusions: Specific, theoretically based, testable interventions to improve caries prevention and management were coproduced by patient-, practice-, and policy-level stakeholders. Findings emphasize duality of behavioural determinants as barriers and facilitators, patient influence on preventive care delivery, and benefits of integrating multi-level interests when planning interventions in a dynamic, resource-constrained environment. Interventions identified in this study are actively being used to support ongoing implementation initiatives including guidance, professional development, and oral health promotion

Infant Discovery Learning and Lower Extremity Coordination: Influence of Prematurity

<p><i>Aims</i>: Preterm infants at increased risk for neurodevelopmental disabilities, including cerebral palsy, demonstrate reduced selective leg joint coordination. Full-term infants demonstrate more selective hip–knee coordination when specific leg actions are reinforced using an overhead infant mobile. The purpose of this pilot study was to determine the ability of preterm infants to: (1) perform and learn through discovery, the contingency between leg action and mobile activation, and (2) demonstrate more selective hip–knee coordination when leg actions are reinforced with mobile activation. <i>Methods</i>: At both 3 and 4-months corrected age, ten infants born very preterm and with very low birth weight participated in 2 sessions of mobile reinforcement on consecutive days. <i>Results</i>: The preterm group at 4-months, but not 3-months, learned the contingency between leg action and mobile activation. Preterm infants at 4-months were separated into those that learned (n = 6) and did not learn (n = 4) the contingency. As a group, preterm infants at 4-months who learned the contingency, did not demonstrate more selective hip–knee coordination when interacting with the mobile on Day 2 as compared to spontaneous kicking on Day 1. <i>Conclusions</i>: Preterm infants, as compared to full-term infants, may have difficulty producing more selective hip–knee coordination during task-specific leg action.</p

Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy

Importance Cerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years. Objective To systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support. Evidence Review The literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument. Findings Sixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5). Conclusions and Relevance When a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline