Early motor and respiratory re-education in patients hospitalized for COVID-19

To develop multivariate models for prediction of early motor deficit improvement in acute stroke patients with focal extremity paresis, using admission clinical and imaging data. Eighty consecutive patients with motor deficit due to first-ever unilateral stroke underwent CT perfusion (CTP) within 9 hours of symptom onset. Limb paresis was prospectively assessed using admission and discharge NIH Stroke Scale (NIHSS) scoring. CTP scans were coregistered to the MNI-152 brain space and subsegmented to 146 pairs of cortical/subcortical regions based on preset atlases. Stepwise multivariate binary logistic regressions were performed to determine independent clinical and imaging predictors of paresis improvement. The rates of early motor deficit improvement were 18/49 (37%), 15/42 (36%), 8/25 (32%), and 7/23 (30%) for the right arm, right leg, left arm, and left leg, respectively. Admission NIHSS was the only independent clinical predictor of early limb motor deficit improvement. Relative CTP values of the inferior frontal lobe white matter, lower insular cortex, superior temporal gyrus, retrolenticular portion of internal capsule, postcentral gyrus, precuneus parietal gyri, putamen, and caudate nuclei were also independent predictors of motor improvement of different limbs. The multivariate predictive models of motor function improvement for each limb had 84%-92% accuracy, 79%-100% positive predictive value, 75%-94% negative predictive value, 83%-88% sensitivity, and 80%-100% specificity. We developed pilot multivariate models to predict early motor functional improvement in acute stroke patients using admission NIHSS and atlas-based location-weighted CTP data. These models serve as a "proof-of-concept" for prospective location-weighted imaging prediction of clinical outcome in acute stroke.

BackgroundParkinson’s disease is a disabling neurodegenerative movement disorder characterized by dopaminergic neuron loss induced by α-synuclein oligomers. There is an urgent need for disease-modifying therapies for Parkinson’s disease, but drug discovery is challenged by lack of in vivo models that recapitulate early stages of neurodegeneration. Invertebrate organisms, such as the nematode worm Caenorhabditis elegans, provide in vivo models of human disease processes that can be instrumental for initial pharmacological studies.MethodsTo identify early motor impairment of animals expressing α-synuclein in dopaminergic neurons, we first used a custom-built tracking microscope that captures locomotion of single C. elegans with high spatial and temporal resolution. Next, we devised a method for semi-automated and blinded quantification of motor impairment for a population of simultaneously recorded animals with multi-worm tracking and custom image processing. We then used genetic and pharmacological methods to define the features of early motor dysfunction of α-synuclein-expressing C. elegans. Finally, we applied the C. elegans model to a drug repurposing screen by combining it with an artificial intelligence platform and cell culture system to identify small molecules that inhibit α-synuclein oligomers. Screen hits were validated using in vitro and in vivo mammalian models.ResultsWe found a previously undescribed motor phenotype in transgenic α-synuclein C. elegans that correlates with mutant or wild-type α-synuclein protein levels and results from dopaminergic neuron dysfunction, but precedes neuronal loss. Together with artificial intelligence-driven in silico and in vitro screening, this C. elegans model identified five compounds that reduced motor dysfunction induced by α-synuclein. Three of these compounds also decreased α-synuclein oligomers in mammalian neurons, including rifabutin which has not been previously investigated for Parkinson’s disease. We found that treatment with rifabutin reduced nigrostriatal dopaminergic neurodegeneration due to α-synuclein in a rat model.ConclusionsWe identified a C. elegans locomotor abnormality due to dopaminergic neuron dysfunction that models early α-synuclein-mediated neurodegeneration. Our innovative approach applying this in vivo model to a multi-step drug repurposing screen, with artificial intelligence-driven in silico and in vitro methods, resulted in the discovery of at least one drug that may be repurposed as a disease-modifying therapy for Parkinson’s disease.

The relations between attention-deficit hyperactivity disorder (ADHD) and motor skills are well documented, with research indicating both early and lifelong motor deficits in children with this disorder. Despite neuroanatomical and neurodevelopmental differences, which may predict differential rates of motor impairment between ADHD subtypes, evaluation of motor skill deficits in children with different presentations are limited in scope and equivocal in findings. The present investigation evaluated early motor development history and objectively measured motor skills in children with ADHD-Inattentive subtype (ADHD-I) and ADHD-Combined subtype (ADHD-C). One hundred and one children with ADHD-I (n = 53) and ADHD-C (n = 48) were included. Variables included Full-Scale IQ (FSIQ), history of motor delays, and utilization of early intervention services, as well as objectively measured motor impairment as assessed via tasks of fine-motor coordination. No between-group differences were found for FSIQ, but differences in age emerged, with the ADHD-I group being older. No differences in early motor delays were observed, though a considerably higher percentage of children with ADHD-C demonstrated early difficulties. Surprisingly, although children and adolescents with ADHD-C reported more frequent utilization of early intervention services, those with ADHD-I exhibited greater levels of current motor impairment on objective tasks. Given the over-representation of older children in the ADHD-I group, data were reanalyzed after excluding participants older than 10 years of age. Although the between-group differences were no longer significant, more than twice the number of parents of children with ADHD-C reported early motor delays, as compared with the ADHD-I group. Overall, children with ADHD-I were more likely to exhibit current objectively measured motor impairment, possibly due to later identification, less intervention, and/or different neurodevelopmental substrates underlying this disorder subtype.

Early motor delays and differences are common among children with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Yet, little work has shown whether there are early atypical motor signs that differentiate these groups. Quantitative measures of movement variability hold promise for improving the identification of subtle and specific differences in motor function among infants and toddlers at high likelihood for ASD and ADHD. To this end, we created a novel quantitative measure of movement variability (movement curvature) and conducted a preliminary investigation as to whether this measure improves outcome predictions. We used a wearable triaxial accelerometer to evaluate continuous motion-based activity in infants at high and low likelihood for ASD and ADHD at 12, 18, 24, and 36 months of age. At 36 months, participants were categorized into three outcome groups: ASD , ADHD concerns , and a comparison group . We examined group differences in movement curvature and whether movement curvature is predictive of a later ASD or ADHD concerns classification. We found that movement curvature was significantly lower in infants with later ASD diagnosis at 18, 24, and 36 months of age compared to infants with either ADHD concerns or those in the comparison group. Movement curvature was also a significant predictor of ASD at 18, 24, and 36 months and when adjusting for high ASD likelihood at 18 and 24 months . These results indicate that lower movement curvature may be a feature of early motor differences in infants with later ASD diagnosis as early as 18 months of age.

Objective Comparative analysis for the risk factors associated with early progressive motor deficits in cerebral infarcts of different sizes in white matter of basal ganglia region and the relation between infarctions and middle cerebral artery stem lesions. Methods All 120 patients with single acute infarction located in white matter of basal ganglia region were recruited in this study retrospectively. All patients had brain and neck magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) within 72 h after onset. They were divided into two groups:the first group (n=60，maximal size of infarctions in diameters were from 1.5 cm to 3.0 cm) and the second group (n=60，maximal diameters＜1.5 cm) based on the maximal diameters of the infarctions on diffusion weighted imaging (DWI). Dynamic National Institutes of Health Stroke Scale （NIHSS) in 7 days after the admission were evaluated, and analyzed by multiple Logistic regression to estimate the independent contribution of the risk factors to the early progressive motor deficits. Then, each of 2 groups was subdivided into 5 subgroups according to the MRA and clinical symptoms. Correlation between infarction and extracranial-intracranial artery lesion was analyzed. Results The proportion of patients with early progressive motor in the first group was significantly higher than that in the second group (19/60，31.6% vs 5/60，8.3%，χ2＝4.671，P=0.001). By multiple logistic regression analysis, elevated systolic blood pressure on admission（odds ratio(OR)=5.42， 95% confidence interval (CI) 1.507—10.063，P=0.016） was independently related to early progressive motor deficits. The proportion of middle cerebral atery stem lesion in the first group was significantly higher than that in the second group（24/60，40.0% vs 5/60，8.3%， χ2=0.916，P=0.000）. Conclusions Patients with acute single infarction located in white matter of basal ganglia and with diameters of 1.5 cm to 3.0 cm are at higher risk of early progressive motor deficits. Elevated systolic blood pressure on admission is the most significant independent factor related to early progressive motor deficits. The pathogenic mechanism of these middle size infarctions may be associated with lesions in middle cerebral artery stem. Key words: Cerebral infarction; Movement disorders; Magnetic resonance imaging; Risk factors

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Various factors, including culture, influence early childhood motor development, which is an important component of child development. Indonesia, with its cultural diversity, provides a rich context for studying differences in children's motor development. This study aims to review the existing literature on early childhood motor development across different cultures in Indonesia, particularly in Java, Madura, Papua and Bali. The article compares research results from the four cultures and provides a broad understanding of how cultural contexts influence early childhood motor development. This research uses a literature review. Using keywords such as “early childhood motor development”, “Javanese culture”, “Madurese culture”, “Papuan culture”, and “Balinese culture”, relevant literature was collected through searches in academic databases such as Google Scholar, PubMed, and Indonesia OneSearch. Included articles were those published in the last two decades and focused on early childhood motor development in each of the four cultures. The review showed that in Java, traditional games such as “engklek” and “congklak” play a significant role in supporting fine and gross motor development. In Madura, parenting practices that involve physical activities such as taking children to the fields help improve gross motor skills. In Papua, active lifestyles and intense physical activities, such as walking long distances and climbing trees, accelerate the achievement of gross motor milestones. While in Bali, participation in traditional dance and handicraft making supports children's fine and gross motor development. The conclusion is that cultural elements play a significant role in early childhood motor development in Indonesia. To maximize children's development within their respective cultural contexts, educators, parents and health professionals should have an understanding of these cultural influences. Recommendations for further research and culturally appropriate intervention programs are also presented.

Various factors, including culture, influence early childhood motor development, which is an important component of child development. Indonesia, with its cultural diversity, provides a rich context for studying differences in children's motor development. This study aims to review the existing literature on early childhood motor development across different cultures in Indonesia, particularly in Java, Madura, Papua and Bali. The article compares research results from the four cultures and provides a broad understanding of how cultural contexts influence early childhood motor development. This research uses a literature review. Using keywords such as “early childhood motor development”, “Javanese culture”, “Madurese culture”, “Papuan culture”, and “Balinese culture”, relevant literature was collected through searches in academic databases such as Google Scholar, PubMed, and Indonesia OneSearch. Included articles were those published in the last two decades and focused on early childhood motor development in each of the four cultures. The review showed that in Java, traditional games such as “engklek” and “congklak” play a significant role in supporting fine and gross motor development. In Madura, parenting practices that involve physical activities such as taking children to the fields help improve gross motor skills. In Papua, active lifestyles and intense physical activities, such as walking long distances and climbing trees, accelerate the achievement of gross motor milestones. While in Bali, participation in traditional dance and handicraft making supports children's fine and gross motor development. The conclusion is that cultural elements play a significant role in early childhood motor development in Indonesia. To maximize children's development within their respective cultural contexts, educators, parents and health professionals should have an understanding of these cultural influences. Recommendations for further research and culturally appropriate intervention programs are also presented.

Early childhood motor development is an important indicator of short- and long-term health. In utero exposures impact offspring health across the lifespan; however, whether maternal activity during pregnancy may impact early childhood motor development remains unknown. This prospective cohort study measured the motor development skills of n = 70 children born to mothers from a previously conducted cohort study which objectively measured activity profile, (sedentary behavior (SED) and moderate-to-vigorous intensity physical activity (MVPA), across pregnancy. Mothers reported the motor development of their child using the Early Motor Questionnaire (EMQ). Linear regression models examined associations between maternal activity profile and EMQ scores. Maternal SED and MVPA were analyzed in two ways: trimester-specific and across pregnancy using trajectory groups. Children were 12–30 months of age, majority white (82%), and 52% male. Maternal SED during pregnancy was not associated with any EMQ domains (gross motor, fine motor, and perception action). Higher maternal MVPA, across pregnancy by trajectory group and in the first and second trimesters, was significantly associated with moderate-sized effects of more advanced fine motor and perception action scores. Higher MVPA in early pregnancy appears to be related to more advanced early childhood motor development. Therefore, maternal MVPA may be a modifiable behavior by which short- and long-term offspring health may be impacted.

Maternal depression and child development: short and long term sequelae for mothers, infants, and families

This mixed-method case study explores early motor delays in an extremely premature infant and provides the mother's perspective on raising an infant whose future development is uncertain. Infant motor testing was completed at term age, 6 weeks, and 12 weeks. Magnetic resonance spectroscopy (MRS) was performed at 41 weeks corrected age after the infant scored below average on infant motor assessments. A parent interview and follow-up motor testing was completed at 10 months. The infant scored below average or low average on infant motor tests at all time periods. MRS results revealed mild abnormalities in white matter. The qualitative interview highlighted the mother's anxiety over early motor delays. Although motor delays were manifest during early motor testing, the infant received only brief early intervention (EI) but no additional therapy services. This case serves as an example of the difficulty identifying early motor delays in this high-risk population resulting in inconsistent utilization of EI services. This study's finding are supported by recent motor studies that have identified very early motor skill markers that serve as red flags for developmental disorders such as cerebral palsy or autism. These markers of atypical early head, arm, leg, or trunk movements could be used as part of more sensitive early developmental screenings that could be used by early interventionists, pediatricians, or occupational therapists to help identify those infants at highest risk for later delay. Larger studies are needed to further define standardized testing that could identify early motor deficits in extremely premature infants.

The Early Motor Questionnaire (EMQ): A parental report measure of early motor development

A growing number of literature data suggest the presence of early impairments in the motor development of children with autism spectrum disorder, which could be often recognized even before the appearance of the classical social communication deficits of autism. In this narrative review, we aimed at performing an update about the available data on the early motor function in children with autism spectrum disorder. Early motor impairment in these children can manifest itself both as a mere delay of motor development and as the presence of atypicalities of motor function, such as a higher rate and a larger inventory, of stereotyped movements both with and without objects. In the perspective of a timely diagnosis, the presence of early motor signs can be an important clue, especially in an individual considered at high risk for autism. Motor and communication (both verbal and non-verbal) skills are connected and a pathogenetic role of early motor dysfunctions in the development of autism can be hypothesized. From this, derives the importance of an early enabling intervention aimed at improving motor skills, which could also have favorable effects on other aspects of development.

This research is a qualitative research to describe and analyze the role of mothers as informal educators in stimulating the motor development of early childhood in Kedung Jaya Village, Bogor. The problems in this study are formulated as follows: what is the role of mothers as informal educators in stimulating motor development in early childhood in Kelurahan Kedung Jaya Bogor? The method in this study uses qualitative descriptive analysis methods. The selection of data sources using purposive sampling, namely mothers with early childhood who live in Kedung Jaya Village, Bogor, totaling 3 mothers and 4 children. Data collection uses observation, interview and documentation techniques. Data analysis includes 3 phases, namely: data reduction, data presentation, conclusion drawing and verification. Checking or checking the validity of the data is carried out by triangulation, including: source triangulation and engineering triangulation. Based on the exposure and research findings, it was found that the role of mothers as informal educators in stimulating early childhood motor development has not shown ideal results. Optimizing the role of mothers as informal educators will have a major impact on early childhood motor development. The success of the mother in stimulating the motor development of the child is influenced by the age, level of education, knowledge, living environment, physical condition of the mother and the socioeconomic conditions of the family. Early childhood motor development is one of the important aspects of development for a child's future, therefore researchers recommend two important things that mothers can do in an effort to improve early childhood motor development, namely: 1) Delegating childcare to early childhood education (ECCE) institutions if the mother is working or unable to stimulate the child's motor development, 2) Providing quality time with the child.

IntroductionPeople with spinal cord injury receive physical rehabilitation to promote neurological recovery. Physical rehabilitation commences as soon as possible when a person is medically stable. One key component of physical...