Impaired Fine Motor Skills Research Articles

A-41 Not Just a “Clumsy” Kid: A Case Study of Developmental Coordination Disorder

Abstract Objective Developmental Discoordination Disorder (DCD) is an often overlooked and seldom diagnosed neurodevelopmental condition marked by impairments in motor skills. Lacking identifiable medical or neurological etiology, children with DCD often have preserved intellectual abilities. Comorbidity is common, including ADHD and specific learning disability. Despite extensive evidence of significant impact on daily activities and academics due to differences in motor behaviors, DCD difficulties are regularly treated as behavioral problems. Method Neuropsychological evaluation of an 8-year-old boy with a possible reading delay and inability to perform some age-appropriate academic and self-care tasks. Results Average overall ability with very strong verbal performances; intact visual perceptual processing, memory, and non-written language. Academics are within expected range, although graphomotor weakness impacted academic performances on tasks with written demands. Patient appeared clumsy and awkward with low muscle tone, poor balance, and difficulty learning new motor skills. Impaired fine motor control, handwriting, gait, gross motor skills, motor planning, coordination, and oromotor weakness as well as inferior verbal language abilities were evident. Impulsivity, inattention, poor planning, and poor self-monitoring were also evident. Conclusions DCD is evidenced by impairment in fine and gross motor skills, oromotor skills, motor planning, energy, and coordination with clear discrepancy between motor abilities and abilities in other areas, specifically language. In our case, DCD features were overlooked despite wide ranging impact. ADHD and SLD with impairment in written expression were concurrent. This case highlights the need for greater appreciation of DCD so that children can benefit from early detection and intervention considering the life-long implications of the disorder.

Analysis of Fine Motor Skills in Essential Tremor: Combining Neuroimaging and Handwriting Biomarkers for Early Management.

Essential tremor (ET) is a highly prevalent neurological disorder characterized by action-induced tremors involving the hand, voice, head, and/or face. Importantly, hand tremor is present in nearly all forms of ET, resulting in impaired fine motor skills and diminished quality of life. To advance early diagnostic approaches for ET, automated handwriting tasks and magnetic resonance imaging (MRI) offer an opportunity to develop early essential clinical biomarkers. In this study, we present a novel approach for the early clinical diagnosis and monitoring of ET based on integrating handwriting and neuroimaging analysis. We demonstrate how the analysis of fine motor skills, as measured by an automated Archimedes’ spiral task, is correlated with neuroimaging biomarkers for ET. Together, we present a novel modeling approach that can serve as a complementary and promising support tool for the clinical diagnosis of ET and a large range of tremors.

Rapid Neurodevelopmental Assessment (RNDA) : An Important Tool for Assessment of Psychomotor Development in Children with Perinatal Events

Background: Infants with various perinatal events are at risks for long term neurodevelopmental impairments. Neurodevelopmental assessment at early life has been considered as a valuable tool for prediction of neurodevelopmental outcomes in this population. This present study aimed to identify the neurodevelopmental impairments in high risk children by Rapid Neurodevelopment Assessment (RNDA)
 Materials and methods : This was a cross sectional study conducted in the Autism and Child Development Centre of Chattogram Maa Shishu-O-General Hospital during the period of 0ctober to December 2018. Babies aged 0 -2 years with different perinatal events like prematurity, birth asphyxia, neonatal jaundice, and without any adverse event; that attended RNDA clinic underwent Rapid Neurodevelopmental Assessment (RNDA) to find at risk children for long term neurodevelopmental impairments.
 Results: Among the 50 study subjects,Perinatal asphyxia was found in 41(82%). 26(52%) had history of IUGR, 22(44%) had Preterm delivery and 25(50%) had history of Neonatal convulsion. History of neonatal jaundice was found in 14(28%) cases. 5(10%) children did not have any perinatal event. The Mean ± SD age of study subjects was 7.38±7.31month. Severe impairment in gross motor and fine motor function were found in 25(50%) and 24(48%) respondents respectively. Vision was severely impaired in 10(20%) cases. Severe cognition and behavior impairment were found in 8(16%) and 3(6%) cases accordingly. Severe hearing and speech impairment were found in 2(4%) & 10(20%) cases respectively. Severe seizure was found in 19(39%) cases. Study subjects with the history of delayed cry or Perinatal asphyxia had significantly decreased fine motor skills. Children born with IUGR had significant gross motor and fine motor skill impairment. Significant speech & cognitive impairment were observed in children with neonatal jaundice. Seizure was found significant in study subjects with a history of neonatal convulsion.
 Conclusion: Rapid Neurodevelopment Assessment (RNDA) plays an important role for early identification of neurodevelopmental impairments of high-risk infants and thus screening for these can promote early therapeutic intervention and subsequent follow up, leading to better outcome.
 Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 16-21

Characterization of Autism Spectrum Disorder (ASD) subtypes based on the relationship between motor skills and social communication abilities.

Motor abnormalities are generally observed in autism spectrum disorder (ASD), and motor difficulties are certainly evident during the early years of life and may thus precede social-communication impairments. The main aim of the present study was to examine ASD subtypes based on the relationship between motor skills and social communication abilities. Motor skills and social communication abilities were evaluated through the Movement Assessment Battery for Children-Second Edition, the Autism Diagnostic Observation Schedule-Second Version and the Psychoeducational Profile-Third Edition. In addition, social communication abilities were classified according to the Autism Classification System of Functioning: Social Communication-ACSF:SC criteria. We found that children with ASD presented poorer motor skills than their TD peers, and motor impairments correlated with poorer social communication abilities in children with ASD. In addition, children with lower social and communication functioning showed a more prominent impairment in manual dexterity and fine motor skills than children with better social and communication functioning. In conclusion, we suggest that stratifying children with ASD based on motor and social endophenotypes may be useful to understand the neurobiological mechanisms of ASD and lead to new types of treatment.

Visual pedagogy-guided toothbrushing training to enhance fine motor skills in individuals with intellectual disabilities and impaired fine motor skills.

To evaluate the effect of visual pedagogy-guided toothbrushing training on oral hygiene, toothbrushing ability, and fine motor skills in individuals with intellectual disability (ID) and impaired fine motor skills. This quasi-experimental study comprised 37 subjects aged 6-24 years. The plaque index (PI), gingival index (GI), toothbrushing ability, and fine motor skills were evaluated before and after 3 and 6 months of individual visual pedagogy-guided toothbrushing training. Friedman's post hoc test and Spearman's correlation coefficient were used for statistical analyses. The PI, GI, toothbrushing ability, and fine motor skills of the 23 subjects who remained in the study at the 6-month follow-up period significantly improved from those measured at baseline (p<0.05). A significant association was observed between the improvements in both toothbrushing ability and fine motor skills (p<0.05). Visual pedagogy-guided toothbrushing training could improve the oral hygiene and toothbrushing ability of individuals with ID and impaired fine motor skills. Moreover, improvements in the toothbrushing ability could enhance the fine motor skills of these individuals.

N-acetylcysteine relieves neurologic signs of acute ethanol hangover in rats

Introduction: Alcohol abuse is one of the grave social and medical problems in many countries, including Russia. Alcohol not only negatively affects health, social and family relationships, but also a person’s performance. Hangover, which is a one of the negative consequences of alcohol intake, is a complex of neurological and somatic symptoms that occur when ethanol is almost completely metabolized to acetaldehyde. This condition, despite the severity and potential economic damage, remains poorly understood, and there are no effective medicines to treat it.&#x0D; Aim: to provide an experimental basis for the possibility of using N-acetylcysteine (NAC), a precursor of glutathione, as a medicine for prevention of the neurological and cognitive impairments due to alcohol intoxication.&#x0D; Materials and Methods: The study used male Wistar rats, which were intraperitoneally injected with ethanol at a dose of 3 g/kg to simulate acute ethanol intoxication. Sixty minutes before the injection, the animals from the experimental groups were gavaged with NAC (1 g/kg) or with an equivalent volume of saline. Immediately after awakening and 3 h after it, the animals were assessed for neurological deficits, motor skills, spontaneous motor activity, and cognitive functions. After the completion of the behavioral tests, the animals were euthanized to assess the level of glutathione, triglycerides (TGs), and malonic dialdehyde (MDA) in liver homogenates, and to determine the activity of enzymatic antioxidant systems and serum aminotransferases.&#x0D; Results and Discussion: The ethanol intoxication in the animals from the control group was associated with pronounced signs of neurological and cognitive impairments, including low spontaneous motor and exploratory activity, impaired fine motor skills in the adhesive test, and cognitive function decline in the Morris water maze test. The rats which had received NAC before ethanol injection demonstrated better fine motor skills in the adhesive test, a higher level of spontaneous motor activity and better performance in the Morris water maze test (in comparison to the animals treated with saline before alcohol intoxication). In the animals which had received NAC, the levels of glutathione, MDA, and TGs, as well as the activity of liver antioxidant enzymes, were closer to the values of the intact rats to a greater extent than in the animals that had been injected with ethanol and received saline.&#x0D; Conclusion: Orally administered NAC before acute ethanol intoxication led to a decrease in the severity of neurological deficiency in rats and reduced the amnesic effect of ethanol. This could be due to an improvement of ethanol metabolism and a decrease in the severity of disorders associated with oxidative stress and liver dysfunction.

INTERDEPENDENCE OF HEREDITY, ENVIRONMENT AND UPBRINGING IN THE FORMATION AND DEVELOPMENT OF PERSONALITY

The article is devoted to the analysis of the research of the Dutch professor Dick Ferdinand Swaab in the context of interdependence and interplay of heredity, environment and upbringing on the formation and development of personality. The authors, conducting a critical review of Dick Swaab’s publications, were focused on the important features of personality formation, integrating in this context information from psychology, pedagogy and neurobiology. The publication shows the close connection of all factors influencing the formation of personality; their interdependence and interdependence at different age stages of personality development are proved. Indicated clear correlation between research on neurobiology and pedagogy, in this context, mutual proven link between the sciences and their joint impact on people. It is determined that the fatal development of personality significantly depends on the individual characteristics of the material, shows the influence of bad habits of materials on genetic mutations in humans. It is shown that intellectual development is a complex process that depends on both the genetic makeup of the person and the environment. It is proved that upbringing and social interaction were and remain the drivers of cultural and civilizational formation of the individual at different age stages. Emphasis is placed on the fact that social contact is an important factor in hormonal processes within the human body; it is shown that the processes of personality formation are actively influenced by external factors (optimal proportion of movement and sleep, failure of the biological clock, stress, impaired fine motor skills, etc.). It is shown that economic status is one of the factors of intellectual development of children with developmental disabilities. The study, based on the basic practical results obtained by Professor Dick Swab, presents the need for a thorough study of these interdependencies and the relationship of students of pedagogical specialties in the context of providing training for future educators.

Preoperative neurodevelopment of children with moyamoya angiopathy.

To preoperatively assess the neurodevelopment of a predominantly white population of children with moyamoya angiopathy (MMA). Assessments of 40 children with MMA (24 females, 16 males; mean age 6y 11mo, range 20mo-16y) included tests for non-verbal IQ and fine motor skills, and questionnaires on quality of life, behaviour, and executive functions. The Paediatric Stroke Outcome Measure (PSOM) score was evaluated by a paediatric neurologist. Children with MMA had significantly lower non-verbal IQ scores (mean IQ 92.1, SD 19.6, p=0.015) and fine motor skills (z-score -1.84, p=0.004) than population norms. Patients with posterior cerebral artery (PCA) involvement had poorer non-verbal IQ scores than those without (79.6, SD 24.6 vs 95.2, SD 17.2, p=0.042). Higher PSOM scores were related to lower non-verbal IQ scores (Spearman's rank correlation coefficient -0.43, p=0.006), while the presence of stroke, bilaterality, disease versus syndrome, and age at diagnosis had no significant effect on non-verbal IQ. Quality of life, behaviour, and executive functions were in the typically developing range. Children with MMA are more likely to manifest intellectual and fine motor skill impairment before surgical intervention. PCA involvement is an additional risk factor for lower non-verbal IQ. Children with moyamoya angiopathy have intellectual and fine motor skill impairment before surgical intervention. Posterior cerebral artery involvement and higher Paediatric Stroke Outcome Measure scores may predict poorer performance.

Women with Fragile X-associated Tremor/Ataxia Syndrome.

Fragile X-associated tremor and ataxia syndrome (FXTAS) is a late-onset neurodegenerative disorder linked to the FMR1 premutation. FXTAS in women is far less common than in men, and this study represents the largest sample reported to date. A total of 53 female premutation carriers with FXTAS (meanage, 66.83 years; FXTAS stages 2-5) and 55 age-matched and demographic background-matched control participants (meanage, 61.94 years) underwent a comprehensive molecular, physiological, neuropsychological, and psychiatric assessment. The large sample of female premutation carriers showed a wide range of variability of clinical signs and symptom progression. The imaging results showed a middle cerebellar peduncles sign in only 6 patients; another symptom included high-signal intensity in the splenium of the corpus callosum, and diffuse cerebral deep white matter changes (e.g., in the pons) are more common. The rate of psychiatric disorders, especially depression, is higher than in the general population. There is a clear impairment in executive functioning and fine motor skills in connection with a higher FXTAS stage. The manifestation of FXTAS symptoms in female carriers can be diverse with a milder phenotype and a lower penetrance than those observed in male premutation carriers. The middle cerebellar peduncles sign is present in only a small percentage of the sample, and we propose that the imaging criteria for FXTAS in women need to be expanded.

Impaired Cortical Cytoarchitecture and Reduced Excitability of Deep-Layer Neurons in the Offspring of Diabetic Rats.

Maternal diabetes has been related to low verbal task scores, impaired fine and gross motor skills, and poor performance in graphic and visuospatial tasks during childhood. The primary motor cortex is important for controlling motor functions, and embryos exposed to high glucose show changes in cell proliferation, migration, and differentiation during corticogenesis. However, the existing studies do not discriminate between embryos with or without neural tube defects, making it difficult to conclude whether the reported changes are related to neural tube defects or other anomalies. Furthermore, postnatal effects on central nervous system cytoarchitecture and function have been scarcely addressed. Through molecular, biochemical, morphological, and electrophysiological approaches, we provide evidence of impaired primary motor cerebral cortex lamination and neuronal function in pups from diabetic rats, showing an altered distribution of SATB2, FOXP2, and TBR1, impaired cell migration and polarity, and decreased excitability of deep-layer cortical neurons, suggesting abnormalities in cortico-cortical and extra-cortical innervation. Furthermore, phase-plot analysis of action potentials suggests changes in the activity of potassium channels. These results indicate that high-glucose insult during development promotes complex changes in migration, neurogenesis, cell polarity establishment, and dendritic arborization, which in turn lead to reduced excitability of deep-layer cortical neurons.

The Relationship Between Air Pollution and Cognitive Functions in Children and Adolescents: A Systematic Review.

Air pollution has a negative impact on one's health and on the central nervous system. We decided to assess studies that evaluated the relationship between air pollution and cognitive functions in children and adolescents by reviewing studies that had been published between January 2009 and May 2019. We searched three major databases for original works (26 studies) and for studies using brain imaging methods based on MRI (six studies). Adverse effects of air pollutants on selected cognitive or psychomotor functions were found in all of the studies. Exposure to nitrogen dioxide, for example, was linked to impaired working memory, general cognitive functions, and psychomotor functions; particulate matter 2.5 was linked to difficulties in working memory, short-term memory, attention, processing speed, and fine motor function; black carbon was linked to poor verbal intelligence, nonverbal intelligence, and working memory; airborne copper was linked to impaired attentiveness and fine motor skills; isophorone was linked to lower mathematical skills; and polycyclic aromatic hydrocarbons in fetal life were linked to lower intelligence scores. The studies using MRI showed that high concentrations of air pollutants were linked to changes in the brain's white matter or lower functional integration and segregation in children's brain networks. In view of the global increase in air pollution, there is a need for further research to elucidate the relationship between air pollution and cognitive and motor development in children. According to some studies, neuroinflammation, the e4 allele of the apolipoprotein E gene, and gutathione-S-transferase gene polymorphism processes may play a role.

Синдром ограниченной подвижности суставов как предиктор развития синдрома диабетической стопы

Diabetes mellitus (DM) can lead to the development of late complications. In addition to the traditional late complications, a high prevalence of damage to the musculoskeletal system in diabetes was noted. The most appropriate term that reflects the defeat of the musculoskeletal system in diabetes is «limited joints mobility syndrome» (LJM). Damage to the hands in the presence of open painless stiffness of the joints, fixed flexion contractures, impaired fine motor skills of the hands and grip forces. Subsequently, it became clear that, over time, the restriction of joint mobility develops not only in the small joints of the hands, but also in other large and small joints of the limbs. Traditionally, LJM syndrome pays low attention on the part of practitioners in comparison with other micro- and macrovascular complications of diabetes, even though LJM can significantly impair functional activity, self-care, and impair the quality of life. It is assumed that damage to the periarticular tissues and joints in DM is caused by the accumulation of end glycation products. A decisive place in the diagnosis of LJM is the clinical examination. In the presence of LJM syndrome, the osteoarticular structures of the feet can be affected, timely diagnosis can lead to the development of diabetic foot syndrome.

Limited joint mobility syndrome as a predictor of the diabetic foot syndrome

Diabetes mellitus (DM) can lead to the development of late complications. In addition to the traditional late complications, a high prevalence of damage to the musculoskeletal system in diabetes was noted. The most appropriate term that reflects the defeat of the musculoskeletal system in diabetes is limited joints mobility syndrome (LJM). Damage to the hands in the presence of open painless stiffness of the joints, fixed flexion contractures, impaired fine motor skills of the hands and grip forces. Subsequently, it became clear that, over time, the restriction of joint mobility develops not only in the small joints of the hands, but also in other large and small joints of the limbs. Traditionally, LJM syndrome pays low attention on the part of practitioners in comparison with other micro- and macrovascular complications of diabetes, even though LJM can significantly impair functional activity, self-care, and impair the quality of life. It is assumed that damage to the periarticular tissues and joints in DM is caused by the accumulation of end glycation products. A decisive place in the diagnosis of LJM is the clinical examination. In the presence of LJM syndrome, the osteoarticular structures of the feet can be affected, timely diagnosis can lead to the development of diabetic foot syndrome.

Investigating fine motor deficits during maintenance therapy in children with acute lymphoblastic leukemia.

Children diagnosed with acute lymphoblastic leukemia (ALL) in their early childhood are more susceptible to neuromuscular and musculoskeletal impairments. This cross-sectional study was designed to address different types of fine motor impairments in Egyptian children diagnosed with ALL. Fifty-four children treated for ALL in maintenance phase aged from four to seven years were compared with an age- and sex-matched control group. Fine motor performance was assessed using the total fine motor form of the Bruininks-Oseretsky Test of Motor Proficiency-second edition (BOT-2). Sex- and age-specific norms of BOT-2 were used to calculate scale and standard scores in both groups. Children with ALL had significantly impaired fine motor skills in all subtests and composites of BOT-2 compared with the typically developing group (P<0.00001). Cumulative doses of vincristine, methotrexate, and dexamethasone revealed no significant correlation with any BOT-2 measure. Males performed significantly better than females in all BOT-2 scores except for the fine motor integration subtest and the total fine motor control composite as no significant differences were observed. The protocol risk stratum, duration of maintenance treatment, and the age at assessment did not significantly affect the BOT-2 measures. About 67% of children with ALL on maintenance treatment experienced fine motor difficulties. Periodic evaluation along the course of chemotherapy could identify specific impaired fine motor domains providing the base for a successful rehabilitation program.

Identifying bread wheat lines for high zinc, iron and low phytate concentration

Micronutrient malnutrition, “hidden hunger” affects about two billion people worldwide. It is responsible for escalated morbidity and mortality rates, reduced children’s cognitive ability, diminished labor power productivity and higher chronic diseases prevalence. zinc deficiency causes impairment of physical growth, immune system and learning ability, increased risk of infections, DNA damage and cancer development. Meanwhile, iron deficiency results in tissue hypoxia and heart failure, maternal anemia, stunted and unhealthy babies (born from iron deficient mothers), children with poor attention spans, impaired fine motor skills, less capacity for memory and less work productivity. Nutrition plays a key role in improving quality of agricultural produce and well-being and productivity of the society, hence crop breeding using genetic bio fortification is best option as it reaches every house hold using the seed for cultivation specially bread wheat seed is the most common cultivated cereal in different parts of the country, thus iron and zinc bio fortified wheat will reach every household within the baked bread, thus harvest plus wheat samples provided by Kulumsa agricultural research center, wheat breeding program and the appropriate level of the micro nutrients iron (Fe) and zinc (Zn) determined by Atomic Absorption Spectrophotometer (AAS) and with the anti-nutritional factors (phytate and tannin) were also assessed using UV-Vis spectrophotometer and with respect to upper limit Recommended Daily Allowance (RDA) values per day without any possible effects of overdose intake 8HPAN121(Fe,16.94 mg/ 100g; Zn,1.218 mg/100g), 8HPAN19 (Fe,16.26 mg/ 100g; Zn,1.634 mg/100g), 7HPAN31(Fe,15.64 mg/100 g; Zn,1.97 mg/100 g) and 7HPYT44 (Fe, 17.36 mg/ 100g; Zn, 2.29 mg/ 100 g) of the harvest plus bio fortified wheat had shown promising results since the iron contents had shown to be safer to be consumed twice per day per 100 gram bread considering other sources of iron in day to day food consumed, relatively better zinc content and lower phytate contents consequently be a better candidate for parental cross breeding, adoptability and stability studies in different agro ecological zones and seasons.

ВОССТАНОВЛЕНИЕ МЕЛКОЙ МОТОРИКИ КИСТИ У ПАЦИЕНТОВ С ПАРЕЗАМИ ЦЕНТРАЛЬНОГО ГЕНЕЗА

The development of methods for restoring the motor function of the hand is necessary due to the pronounced negative effect of motor disorders on the patient's quality of life. The aim of the study was to increase the effectiveness of rehabilitation measures in patients with impaired fine motor skills in the wrist due to paresis of central origin through the development and practical application of new scientifically based methodology for training fine motor skills. The clinical material of the study was patients with paresis of central origin. It was proved that inclusion of the proposed method for fine motor skills recovery in the program of the medical rehabilitation of the studied category of patients makes it possible to increase the effectiveness of rehabilitation measures in comparison with using only standard methods.

Participation in leisure activities in adolescents with congenital heart defects.

To describe leisure participation in adolescents with congenital heart defects (CHD) and identify factors associated with intensity of participation. Eighty adolescents with CHD were recruited (39 males, 41 females; mean age [SD] 15y 8mo [1y 8mo] range 11y 5mo-19y 11mo) of whom 78 completed the Children's Assessment of Participation and Enjoyment (CAPE) outcome measure of leisure participation. The measure has five subscales: recreational, active-physical, social, skill-based, and self-improvement. Associations between the CAPE and age, sex, and development were examined. Motor ability (Movement Assessment Battery for Children, Second Edition), cognition (Leiter International Performance Scale-Revised), behavior (Strengths and Difficulties Questionnaire), and motivation (Dimensions of Mastery Questionnaire) were assessed. Participants exhibited impaired motor (43.5%), behavioral (23.7%), and cognitive (29.9%) development. The most intense participation was in social (mean [SD] 3.3 [0.99]) and recreational (2.9 [0.80]) activity types on the CAPE. Male sex (p<0.05) and younger age were associated with greater physical activity (<15y: 1.87; ≥15y: 1.31, p<0.05). Greater engagement in social activities was related to better cognition (r=0.28, p<0.05), higher motor function (r=0.30-0.36, p<0.01), and fewer behavioral difficulties (r=-0.32 to -0.47, p<0.01). Cognitive ability (r=0.27, p<0.05), dexterity and aiming/catching (r=0.27-0.33, p<0.05), and behavior problems (r=0.38-0.49, p=0.001) were correlated with physical activity participation. Persistence in tasks, an aspect of motivation, correlated with physical (r=0.45, p<0.001) and social activity involvement (r=0.28, p<0.05). Ongoing developmental impairments in adolescents with CHD are associated with decreased active-physical and social engagement, putting them at risk of poor physical and mental health. Health promotion strategies should be considered. Adolescents with congenital heart defects (CHD) have limited engagement in active-physical leisure activities. Cognitive, motor, and behavioral impairments are associated with decreased participation in leisure in children with CHD. Female sex and older age are associated with less engagement in leisure. Mastery motivation correlates with participation, suggesting an avenue for intervention.

Characteristics and outcome of influenza-associated encephalopathy/encephalitis among children in a tertiary pediatric hospital in Italy, 2017\u20132019

BackgroundInfluenza is the most frequent cause of acute upper respiratory tract infections during winter season. Although rare, neurological manifestations are known to occur during influenza infection and approximatively three-quarters of cases are in children. In this study, we aimed to characterize the burden and clinical spectrum of influenza-associated encephalopathy and encephalitis in children admitted at a tertiary pediatric hospital in Italy over two influenza seasons (2017–2019).MethodsWe retrospectively analyzed clinical, laboratory, instrumental data and outcome of patients discharged with ICD9-CM 487.0 code.ResultsFifteen children (13.1% of those discharged with a diagnosis of influenza infection in the study period), had influenza-associated central nervous system (CNS) manifestations. Eight patients (53.3%) were diagnosed as influenza encephalitis, 7 (46.7%) as influenza encephalopathy. Median age was 27 months. In children under 2 years of age (40% of all cases) altered consciousness was the most frequent neurological manifestation while respiratory symptoms were present at admission in all cases. Younger children also required intensive care support more frequently. Five subjects (33.3%) presented comorbidity. None of the patients had received seasonal influenza vaccination. The median time from onset of respiratory signs to onset of neurological manifestations was 24 h. Cerebrospinal fluid (CSF) analysis was normal in most patients and polymerase chain reaction for influenza virus RNA on CSF, when performed, was negative in all samples. Neuroradiological investigations, performed in 5 children, reported cortical and subcortical white matter signal alterations. Oseltamivir was administered only in 2 cases. Fourteen patients recovered without sequelae, and only a 2-year-old girl had minimal impairment in fine motor skills at discharge.ConclusionsAll children presenting acute neurological features during influenza season should be evaluated for influenza-associated CNS complications even if the respiratory involvement is mild. Absence of underlying diseases or other risk factors are not protective factors against CNS influenza-associated complications. The lack of CSF pleocytosis does not exclude CNS involvement. Children under 2 years of age are at higher risk of requiring intensive care support.

Impaired fine motor skills in children following extraction of a dense congenital or infantile unilateral cataract

To evaluate fine motor ability in children treated for unilateral congenital or infantile cataract. Twenty-three children 3-13years of age who were treated for unilateral congenital or infantile cataract and 38 age-similar control children were enrolled. Children completed five fine motor skills tasks (unimanual dexterity, bimanual dexterity, drawing trail, aiming, catching) from the Movement Assessment Battery for Children-2. Raw scores were converted into standardized scores, with higher scores indicating better performance. Compared with controls, children treated for unilateral cataract scored lower on drawing trail (P=0.009), aiming (P=0.009), and catching (P<0.001) but not on unimanual (P=0.77) or bimanual dexterity (P=0.31). Poorer affected eye visual acuity was moderately related to poorer performance for unimanual dexterity (r=-0.47; P=0.025), bimanual dexterity (r=-0.50; P=0.014), and catching (r=-0.41; P=0.051). Those with a poor visual outcome (>0.6 logMAR) had worse performance than those with a good visual outcome (≤0.6 logMAR) for all tasks (all P values, 0.008-0.09) except aiming. Cataract type (congenital, 9; infantile, 14) and sensory fusion by Worth 4-Dot testing at 33cm (pass, 10; fail, 13) had no effect on fine motor performance (all P values, 0.12-0.98). In our study cohort, fine motor deficits were found in children treated for congenital or infantile unilateral cataract.

P73-T Electrophysiological investigation of change in central sensory pathways in carpal tunnel syndrome

Summary Objective: In our study, we aimed to investigate the relationship between the change in central sensory pathways and fine motor skills by examining patients with CTS. Methods A total of 37 patients with isolated CTS, 27 patients with diabetes mellitus (DM) and CTS, 21 patients with DM without CTS and 15 healthy controls were included in the study. None of them had polyneuropathy. Routine electrophysiological examination, sensory threshold (ST), somatosensory temporal discrimination threshold (STDT), nine-hole peg test (NHPT) were performed. Dropping objects from hand was questioned. Results The rate of dropping objects showed a trend to be higher in patients with CTS, with or without DM. In all participants who dropped objects, the duration of NHPT was found significantly higher. In CTS group with or without DM, second finger (2f) ST and STDT were higher than healthy individuals and cases with DM, the durations of NHPT was correlated with only 2f ST in all participants who dropped objects whereas there was no correlation with 2f STDT. When the isolated CTS and DM-diagnosed CTS groups were compared, only NHPT placement and total completion durations were longer in DM-diagnosed CTS and the other results were similar. Conclusions Similar to the literature, we showed that there was a maladaptive reorganization process in primary somatosensory cortex (S1), which was evaluated with 2f STDT in all of patient with CTS. But in our results, there is no relationship between the maladaptive reorganization process in S1 and impaired fine motor skills.