Early Detection Of Cerebral Palsy Research Articles

Early detection of cerebral palsy in high-risk infants: diagnostic value of primitive and developmental reflexes as well as ultrasound

Background The incidence of cerebral palsy (CP) has increased due to better survival of high-risk babies. A simple assessment method is needed for the early detection of CP, which can be performed by general practitioners and pediatricians in daily practice.Objectives To assess motor delay, primitive and developmental reflexes, and cerebral ultrasound abnormalities as simple methods for early detection of CP in high-risk infants. We also aimed to evaluate the ease and consistency of the methods for use in daily practice, as well as determine risk factors associated with CP.Methods A prospective cohort study was done on 150 high-risk babies starting from the age of 4 months up to 12 months. We obtained subjects’ histories of motor ability and assessed primitive reflexes and postural reactions at the ages of 4, 6, 9 and 10 months. The diagnosis of CP was established at 6 and 12 months of age. We also determined Kappa test for inter-rater reliability between pediatric residents and pediatric neurologist.Results In 88.7% of subjects, CP was detected in the first 6 months. At 4 months, positive palmar reflex, head lag, and fisting were predictive of CP at 6 months of age. Motor delay, positive palmar grasp reflex, head lag, fisting, and absent protective extension reflex at 6 months were predictive of CP at 12 months. At 9 to 10 months, motor delays, absent protective extension reflex, and negative parachute reaction were predictive of CP at 12 months. Cerebral ultrasound abnormalities were predictive of CP at 6 and 12 months of age. Kappa test result was 0.9, indicating the ease and consistency of these methods for daily medical practice.Conclusion Cerebral palsy can be detected as early as the first 6 months of life. Assessment for motor delays, physical examination for asssessing primitive and developmental reflexes, and cerebral ultrasound can be used for this purpose.

Early detection of cerebral palsy in high-risk infants: diagnostic value of primitive and developmental reflexes as well as ultrasound

Background The incidence of cerebral palsy (CP) has increased due to better survival of high-risk babies. A simple assessment method is needed for the early detection of CP, which can be performed by general practitioners and pediatricians in daily practice.Objectives To assess motor delay, primitive and developmental reflexes, and cerebral ultrasound abnormalities as simple methods for early detection of CP in high-risk infants. We also aimed to evaluate the ease and consistency of the methods for use in daily practice, as well as determine risk factors associated with CP.Methods A prospective cohort study was done on 150 high-risk babies starting from the age of 4 months up to 12 months. We obtained subjects’ histories of motor ability and assessed primitive reflexes and postural reactions at the ages of 4, 6, 9 and 10 months. The diagnosis of CP was established at 6 and 12 months of age. We also determined Kappa test for inter-rater reliability between pediatric residents and pediatric neurologist.Results In 88.7% of subjects, CP was detected in the first 6 months. At 4 months, positive palmar reflex, head lag, and fisting were predictive of CP at 6 months of age. Motor delay, positive palmar grasp reflex, head lag, fisting, and absent protective extension reflex at 6 months were predictive of CP at 12 months. At 9 to 10 months, motor delays, absent protective extension reflex, and negative parachute reaction were predictive of CP at 12 months. Cerebral ultrasound abnormalities were predictive of CP at 6 and 12 months of age. Kappa test result was 0.9, indicating the ease and consistency of these methods for daily medical practice.Conclusion Cerebral palsy can be detected as early as the first 6 months of life. Assessment for motor delays, physical examination for asssessing primitive and developmental reflexes, and cerebral ultrasound can be used for this purpose.

Clinical analysis of 52 cases of neuromuscular examination for early screening of cerebral palsy in high risk premature infants

Objective To investigate the effect of 52 neurological tests on early screening of cerebral palsy in high-risk premature infants. Methods 52 Neurological examination were conducted to 363 cases of 28 to 32 weeks of high-risk preterm children at 1 month, 3 months, 6 months respectively after they were birthed from 2009 to 2012. If the children were checked with abnormal items (2 items of checked results were abnormal), they will be closely observed and urge their parents to recheck 1 month later, if the check results were still abnormal, the children would start to be early intervention treated immediately in our department; if the children were checked to have more than 3 items abnormal , he will start to be early intervention treated immediately. Meanwhile, 302 cases of heath premature children without early screening were set up as control group. All children were followed up for 36 months. With the Gesell scale to evaluate the child’s intelligence and sports development. Results 81 Cases of suspected cerebral palsy were found by this method, including 52 cases of early intervention group and 10 cases of untreated group. Another 10 cases were developed for a transient exercise. The positive rate of screening was 92.85%, and the incidence of cerebral palsy was 3.0%. After early intervention, early intervention in the preterm children group were diagnosed cerebral palsy in 5 cases to 36 months later, 17 cases of non-intervention group. Conclusion 52 Neurobehavioral examinations are a effective method for early detection of cerebral palsy in premature children, and it is helpful for early detection of cerebral palsy in premature children, early intervention, as well as to significantly reduce the incidence of cerebral palsy in premature children.

Power Spectral Analysis of EEG as a Potential Marker in the Diagnosis of Spastic Cerebralpalsycases

The detection and diagnosis of various neurological disorders are performed using different medical devices among which electroencephalogram (EEG) is one of the most cost effective technique. Though significant progress had been made in the analysis of EEG for diagnosis of different neurological disorders, yet detection of cerebral palsy (CP) is not quite clear. This study was performed to analyze the EEG power spectrum density (PSD) of spastic CP and normal children to find if any significant EEG patterns could be used for early detection of CP. Twenty children participated in this study out of which ten were spastic CP and other ten were normal healthy children. EEG of all the participants was recorded from C3 C4 and F3 F4 regions following montage 10-20 system. The artifact-free EEG signals of 15 minutes duration was extracted for spectral analysis using Fast Fourier Transformation (FFT) algorithm in MATLAB and power density spectrum (PSD) was plotted. The PSD revealed high intensity power peak at frequency of 50Hz and smaller at 100 Hz, which was consistent for all healthy subjects. In case of spastic CP children, high intensity peak at 100Hz were prominent and smaller peak was observed at 50Hz. The high intensity 100Hz peak observed in the PSD of spastic CP patients demonstrated that this tool can be used for early detection of spastic CP.

Early detection of cerebral palsy among infants and young children, using DDST II

Early detection of cerebral palsy among infants and young children, using DDST II

Impact of intervention: can we affect typical and atypical development of the human brain?

Society becomes increasingly complex. Changes involve altered ways of communication and information exchange, changes in food consumption, changes in motor activities, and in the age at which women have their first child. Postponement of motherhood is associated with an increase in fertility problems and the application of assisted reproductive technology, factors that in turn are associated with an increased risk of preterm birth and low birthweight. Preterm birth and low birthweight are well-known risk factors for developmental disorders, such as CP, developmental coordination disorder, and attention-deficit–hyperactivity disorder. In April 2010, when the Islandic volcano Eijafjällajökull was spitting ash clouds into the air, a workshop was organized in Groningen, the Netherlands, which dealt with vulnerability and plasticity of the developing human nervous system. Leading experts discussed their recent research findings. The aim of the workshop was to address vulnerability and plasticity from neurobiological, neurobehavioural, and clinical perspectives, the last particularly including the consequences for guidance of children with developmental motor disorders. This special issue of Developmental Medicine & Child Neurology is the product of that venture. The first paper by Bryan Kolb et al. reviews cortical plasticity during early development. It highlights the age- and region-specific nature of developmental plasticity and stresses the complexity of early plasticity: many factors may have a positive or negative effect on developmental outcome after a lesion of the brain at early age. The paper by John Martin et al. also deals with plasticity of the young brain. It summarizes a neat series of experiments on activity-dependent plasticity of the young feline brain, which provide challenging insights into possibilities and limitations of early intervention in infants with a unilateral lesion of the brain (see also the commentary in this issue by Gordon and Hadders-Algra). The next two papers, written by Katharina Braun et al. and Bea van den Bergh, deal with the effect of stress during prenatal and early postnatal life. Evidence is accumulating that early stress may programme the brain through complex epigenetic cascades in such a way that it carries an increased risk for the development of psychopathology. The next section addresses two neonatal problems associated with deviant neurodevelopment: hyperbilirubinaemia and preterm birth. Thor Hansen reviews the state of the art in prevention of kernicterus. Gerda van Wezel-Meijler et al., and Arend Bos and Elise Roze discuss the nature and effect of lesions and/or altered neural wiring associated with preterm birth. Kirsten Heineman et al. evaluate the use of the recently developed Infant Motor Profile in the early detection of cerebral palsy (CP) in a high-risk population. The last section deals with the effect of intervention in children with or at high risk for CP. The first three papers, written by Andrea Guzzetta et al., Mijna Hadders-Algra, and Andrew Gordon, address general aspects and the effect of specific activities on developmental outcome. Guzetta et al. present promising results on the effect of massage during the preterm period. Hadders-Algra discusses possibilities but also limitations of early intervention. Gordon elegantly reviews the effects of two types of intervention in children with unilateral spastic CP: constraint-induced movement therapy and bimanual training. He concludes that each method has advantages and disadvantages and that – most importantly – presumably intensity of intervention matters more than the exact nature of the intervention. The last two papers deal with the role of the family in intervention in children with developmental motor disorders. Tineke Dirks et al. review the nature of family involvement in various early intervention programmes, and Peter Rosenbaum stresses that the themes we address in services for children with developmental disorders, and the way we do that, can have important effects on families, and by extension, their children. The papers in this special issue indicate the keen interest of neuroscientists and clinicians in vulnerability and plasticity of the young brain, in particular on the impact of intervention in developmental disorders. They demonstrate that our knowledge of the consequences has increased impressively over the past few years. Nevertheless, there is still much to discover before we understand all of the contributing factors so that we can facilitate functional recovery after a lesion of the young human brain. To achieve this ultimate goal, interdisciplinary translational research is needed, where results from animal models are paired with studies in humans, and studies that use brain imaging techniques are matched with those in which interventions in children are examined to compare functional outcome.

Continuity between Fetal and Neonatal Neurobehavior

Abstract As the development of the brain is unique and continuing process throughout the gestation and after birth, it is expected that there is also continuity of fetal and neonatal movements which are the best functional indicator of developmental processes of the brain. Understanding the relation between fetal and infant behavior and developmental processes of the brain in different periods of gestation may make achievable the distinction between normal and abnormal brain development. Epidemiological studies revealed that many neurologically impaired infants belong to low risk population, which means that they seemed to be developmentally normal as fetuses and as infants, while later childhood neurological disability was diagnosed. Which methods of neurological assessment are available for that purpose? Prenatally we have not many possibilities for neurological assessment, while postnatally the repertoire of diagnostic possibilities is increasing. Among the postnatally available methods for neurological assessment, the most important are: clinical neurological assessment, neuroimaging methods, assessment of general movements (GMs) and combinations. Postnatal neurological assessment is probably easier to perform than prenatal, by using a simple and suitable for everyday work screening clinical test with good reliability, specificity and sensitivity. There is a possibility for the early and simple neurological assessment of the term and preterm newborns with the aim to detect associated risks and anticipate long-term outcome of the infant, and to establish a possible causative link between pregnancy course and neurodevelopmental outcome. The evaluation of infant's developmental optimality should be assessed in order to investigate whether the infant is neurologically normal or damaged. Neurological assessment at term by Amiel-Tison (ATNAT) is taking into account neurological maturation exploring so called lower subcortical system developing earlier from the reticular formation, vestibular nuclei and tectum, and upper cortical system developing from the corticospinal pathways. Conventional acquisition neuroimaging techniques together with modern diffusion neuroimaging techniques can identify typical patterns of brain injury, even in the early course of the disease. However, even though highly suggestive, these patterns cannot be considered as pathognomonic. Nevertheless neuroimaging methods alone are not sufficient to predict the neurological outcome in neonates from highrisk population. Prechtl stated that spontaneous motility, as the expression of spontaneous neural activity, is a marker of brain proper or disturbed function. The observation of unstimulated fetus or infant which is the result of spontaneous behavior without sensory stimulation is the best method to assess its central nervous system capacity. All endogenously generated movement patterns from un-stimulated central nervous system could be observed as early as from the 7-8 weeks of postmenstrual age, with developing a reach repertoire of movements within the next two or three weeks, continuing to be present for 5 to 6 months postnatally. This remarkable fact of the continuity of endogenously generated activity from prenatal to postnatal life is the great opportunity to find out those high-risk fetuses and infants in whom development of neurological impairment is emerging. The most important among those movements are GMs involving the whole body in a variable sequence of arm, leg, neck and trunk movements, with gradual beginning and the end. They wax and wane in intensity, force and speed being fluent and elegant with the impression of complexity and variability. Assessment of GMs in high-risk newborns has significantly higher predictive value for later neurological development than neurological examination. Kurjak and co-workers conducted a study by 4D ultrasound and confirmed earlier findings made by 2D ultrasonography, that there is behavioral pattern continuity from prenatal to postnatal life. Assessment of neonatal behavior is a better method for early detection of cerebral palsy than neurological examination alone. Are we approaching the era when there will be applicable neurological test for fetus and assessment of neonate will be just the continuation? This is still not easy question to answer, because even postnatally there are several neurological methods of evaluation, while in utero we are dealing with more complicated situation and less mature brain. Could neonatal assessment of neurologically impaired fetuses bring some new insights into their prenatal neurological status is still unclear and to be investigated. New scoring system for prenatal neurological assessment of the fetus proposed by Kurjak et al will give some new possibilities to detect fetuses at high neurological risk, although it is obvious that dynamic and complicated process of functional CNS development is not easy to investigate. The aim of this review is to present continuity of the functional central nervous system assessment from prenatal to postnatal life.

The contribution of developmental surveillance to early detection of cerebral palsy

A retrospective study of the contribution of examinations at Child Health Centres (CHC) for early detection of cerebral palsy (CP) was performed in 23,924 children, born in 1986-90, in the south-western part of Stockholm County. The outcome assessed was age of referral to a habilitation unit. A total of 66 children with CP (2.76/1000) were identified through the register at the responsible habilitation unit. The age of referral was, median 8 months, mean 12.4 months and range 0.5-54 months. A peak of referrals at 8-9 months was produced by CHC checks at 6 months of age. No other examination at the CHC resulted in a significant number of referrals. Nineteen records from CHC concerning moderate and severe cases were reviewed. Out of all examinations with aberrant findings only 11/20 resulted in referrals or further examinations. No child with moderate or severe CP was referred due to developmental screening test findings only.

Early Detection of Cerebral Palsy

An Early Motor Pattern Profile (EMPP), consisting of 15 tests of muscle tone, reflexes, and movement, organized in a standardized format, was used to identify children with cerebral palsy (CP) in the first year of life at the University of Illinois at Chicago, College of Medicine at Peoria.

EARLY NEUROMOTOR PREDICTORS OF CEREBRAL PALSY IN LOW BIRTHWEIGHT INFANTS

The purpose of this study was to analyze retrospectively which neuromotor behaviors in a sample of four-month-old low-birthweight infants were most predictive of later cerebral palsy. The infants were evaluated at four months corrected age on the Movement Assessment of Infants (MAI) and were followed to between three and eight years of age. For the CP group as a whole, 17 neuromotor items from the MAI were highly significant (p less than 0.001) predictors of cerebral palsy. A further 15 items also were significant, but less highly so (p less than 0.01 to p less than 0.05). Seven items were predictive of later spastic diplegia, seven of spastic hemiplegia, and 35 items differentiated quadriplegic infants. A shorter version of the MAI should be developed to increase its over-all reliability and validity in the early detection of cerebral palsy. Only then would it be possible to implement early therapeutic intervention and to evaluate its efficacy.

Early neuromotor predictors of cerebral palsy in low-birthweight infants.

The purpose of this study was to analyze retrospectively which neuromotor behaviors in a sample of four-month-old low-birthweight infants were most predictive of later cerebral palsy. The infants were evaluated at four months corrected age on the Movement Assessment of Infants (MAI) and were followed to between three and eight years of age. For the CP group as a whole, 17 neuromotor items from the MAI were highly significant (p less than 0.001) predictors of cerebral palsy. A further 15 items also were significant, but less highly so (p less than 0.01 to p less than 0.05). Seven items were predictive of later spastic diplegia, seven of spastic hemiplegia, and 35 items differentiated quadriplegic infants. A shorter version of the MAI should be developed to increase its over-all reliability and validity in the early detection of cerebral palsy. Only then would it be possible to implement early therapeutic intervention and to evaluate its efficacy.

Significance of Neonatal Electroencephalogram on the Early Detection of Cerebral Palsy and Other Chronic Brain Syndrome

Significance of Neonatal Electroencephalogram on the Early Detection of Cerebral Palsy and Other Chronic Brain Syndrome