Prescription of the first prosthesis and later use in children with congenital unilateral upper limb deficiency: A systematic review

Background: The prosthetic rejection rates in children with an upper limb transversal reduction deficiency are considerable. It is unclear whether the timing of the first prescription of the prosthesis contributes to the rejection rates. Objective: To reveal whether scientific evidence is available in literature to confirm the hypothesis that the first prosthesis of children with an upper limb deficiency should be prescribed before two years of age. We expect lower rejection rates and better functional outcomes in children fitted at young age. Methods: A computerized search was performed in several databases (Medline, Embase, Cinahl, Amed, Psycinfo, PiCarta and the Cochrane database). A combination of the following keywords and their synonyms was used: "prostheses, upper limb, upper extremity, arm and congenital''. Furthermore, references of conference reports, references of most relevant studies, citations of most relevant studies and related articles were checked for relevancy. Results: The search yielded 285 publications, of which four studies met the selection criteria. The methodological quality of the studies was low. All studies showed a trend of lower rejection rates in children who were provided with their first prosthesis at less than two years of age. The pooled odds ratio of two studies showed a higher rejection rate in children who were fitted over two years of age ( pooled OR 3.6, 95% CI 1.6-8.0). No scientific evidence was found concerning the relation between the age at which a prosthesis was prescribed for the first time and functional outcomes. Conclusion: In literature only little evidence was found for a relationship between the fitting of a first prosthesis in children with a congenital upper limb deficiency and rejection rates or functional outcomes. As such, clinical practice of the introduction of a prosthesis is guided by clinical experience rather than by evidence-based medicine

Assessment of spontaneous movements of young infants:An effective method for the detection of disorders of brain function

A method for the assessment of the brain function of young infants was recently introduced. It consists of evaluation of the quality of spontaneously generated generalized movements (general movements, GMs). GMs appear at an early stage of pregnancy and persist until approximately the 4th month after term. Normal GMs are characterized by the triad of complexity, variation and fluency. Mildly abnormal GMs, indicating mild dysfunction of the nervous system, are not fluent but jerky or stiff. Markedly abnormal GMs, indicating major nervous system dysfunction, are characterized mostly by absence of complexity and variation of the movements; the movements are monotonous and stereotyped. The quality of the GMs can be evaluated by means of so-called global Gestalt perception. The technique can be learned in a few days. The quality of the GMs has a clear predictive significance for the child's development. Children with normal GMs will be free of handicaps in later life, whereas three-quarters of the children showing clearly abnormal GMs throughout the postnatal GM period do develop handicaps. Assessment of the quality of the GMs is a relatively cheap, non-invasive method of evaluating the current and future brain function of young infants.</p

Active head lifting from supine in infancy in the general population:Red flag or not?

Background: Previously it had been had reported that active head lifting from supine (AHLS) in high-risk infants was associated with lower cognitive scores in the second year. AHLS was generally accompanied by stereotyped leg movements. Aims: To examine in a standardized way whether AHLS with or without stereotyped leg movements in the general population is associated with prenatal, perinatal, neonatal and socio-economic risk factors or with lower scores on concurrent infant tests. Study design: Cross-sectional study Subjects: 1700 infants aged 2-18 months representative of the Dutch population. Outcome measures: Infant Motor Profile (IMP) and Standardized Infant NeuroDevelopmental Assessment (SINDA). Assessments were video-recorded and included at the youngest ages 3min of behaviour in supine. AHLS and the presence of stereotyped leg movements were recorded. Standardized information on early risk factors was available. Results: AHLS occurred at 4-9 months (prevalence per months: 1-14%; highest prevalence at 6 months). It was not associated with early risk factors or scores on infant tests. When AHLS was accompanied by stereotyped leg movements it was associated with a higher prevalence of an IMP-variation score < P15 (Odds Ratio (OR) 2.472 [95%CI 1.017; 6.006]). Stereotyped leg movements irrespective of AHLS were associated with more unfav-ourable total IMP scores and IMP performance scores (B coefficients-3.212 [-4.065;-2.360],-2.521 [-3.783;-1.259]) and IMP variation and SINDA neurological scores (ORs 5.432 [3.409; 8.655], 3.098 [1.548; 6.202]). Conclusions: The data suggest that AHLS is not a red flag. Rather its co-occurring stereotyped leg movements may signal less favourable neurodevelopment

Occupational therapy home programmes for children with unilateral cerebral palsy using bimanual and modified constraint movement therapies: A critical review. Oral Presentation 3.

status: publishe