Risk Of Motor Impairment Research Articles

Cerebral Palsy and Motor Impairment After Extreme Prematurity: Prediction of Diagnoses at Ages 2 and 10 Years

To identify perinatal factors in children born extremely preterm (EP) that were associated with motor impairment (MI) at 2 and 10years of age and develop a predictive algorithm to estimate the risk of MI during childhood. Participants of the Extremely Low Gestational Age Newborns Study (ELGANS) were classified as: no MI, MI only at 2years, MI only at 10years, and MI at both 2 and 10years, based on a standardized neurological examination at 2 and the Gross Motor Function Classification System (GMFCS) at 10years of age. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to develop the final predictive model. Of the 849 study participants, 64 (7.5%) had a diagnosis of MI at both 2 and 10years and 63 (7.4%) had a diagnosis of MI at 1 visit but not the other. Of 22 total risk factors queried, 4 variables most reliably and accurately predicted MI: gestational age, weight z-score growth trajectory during neonatal intensive care unit (NICU) stay, ventriculomegaly, and cerebral echolucency on head ultrasound. By selecting probability thresholds of 3.5% and 7.0% at ages 2 and 10, respectively, likelihood of developing MI can be predicted with a sensitivity and specificity of 71.2%/72.1% at age 2 and 70.7%/70.7% at age10. In our cohort, the diagnosis of MI at 2years did not always predict a diagnosis of MI at 10years. Specific risk factors are predictive of MI and can estimate an individual infant's risk at NICU discharge of MI at age 10years.

Effects of a Whole-Body General Movement Intervention on Motor Performance, Agility, and Locomotor Skills of Children With Autism Spectrum Disorder: Results From a Comparison Between Face-to-face and Telehealth-Based Intervention Delivery

Background Children with autism spectrum disorder (ASD) demonstrate significant motor impairments in visuomotor and body coordination, agility, and strength. Around 87% of children with ASD are at risk for motor impairments. However, only about 31% of these children receive rehabilitation services to address their motor needs. Objective Our randomized clinical trial assessed the effects of a general movement (GM) intervention compared to a standard-of-care seated play (SP) intervention delivered to children via face-to-face (F2F) and telehealth (TH)–based modes of intervention delivery on motor performance, agility, and locomotor skills in children with ASD. Methods Thirty 5- to 14-year-old children were matched on age, gender, and level of functioning and randomly assigned to the GM or SP groups. Children participated in the study for 10 weeks with pretests and posttests conducted during the first and last weeks and training in the interim 8 weeks with 2 sessions conducted per week. The strength and running speed and agility subtests of Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) and the locomotor subtest of the Test of Gross-motor development (TGMD) were administered at pretest and posttest. In addition, in the GM group, task-specific games involving locomotor skills were assessed during early and late training sessions for changes in movement form or accuracy and the amount of prompting required to complete the actions. Results We found significant improvements in standard scores of the TGMD from pretest to posttest in the GM group (pretest mean 6.1, SE 1.0; posttest mean 8.1, SE 0.9; P<.001) but not the SP group. Within the GM group, there were no significant differences in the rates of improvement for children seen F2F versus via TH (F2F mean 1.8, SE 0.8; TH mean 2.0, SE 1.7; P=.87). On the BOT-2, the GM (pretest mean 36.1, SE 2.6; posttest mean 40.9, SE 3.1; P<.001) but not SP group showed improvements in standard scores on the strength and agility composite. Similar to the trends reported above, there were no differences in the magnitude of improvement for children seen F2F versus via TH (F2F mean 3.7, SD 1.3; TH mean 5.6, SD 1.5; P=.37). On the training-specific test of locomotor skills, children in the GM group improved their movement accuracy (pretest mean 74.4, SE 6.2; posttest mean 86.5, SE 4.7; P<.001) and reduced prompting (pretest mean 22.5, SE 3.5; posttest mean 16.9, SE 4.2; P=.02) required to complete the movements. Both children seen F2F as well as via TH showed similar trends, with no significant differences between the intervention delivery modes. Conclusions Our data suggest that TH is an effective mode of delivery of gross motor interventions and can be used to promote agility and motor coordination in children with ASD. Conflicts of Interest None declared.

Altered microstructure of the splenium of corpus callosum is associated with neurodevelopmental impairment in preterm infants with necrotizing enterocolitis

BackgroundNecrotizing enterocolitis (NEC) is a devastating disease in preterm infants with significant morbidities, including neurodevelopmental impairment (NDI). This study aimed to investigate whether NEC is associated with (1) brain volume expansion and white matter maturation using diffusion tensor imaging analysis and (2) NDI compared with preterm infants without NEC.MethodsWe included 86 preterm infants (20 with NEC and 66 without NEC) with no evidence of brain abnormalities on trans-fontanelle ultrasonography and magnetic resonance imaging at term-equivalent age (TEA). Regional brain volume analysis and white matter tractography were performed to study brain microstructure alterations. NDI was assessed using the Bayley Scales of Infant and Toddler Development-III (BSID-III) at 18 months of corrected age (CA).ResultsPreterm infants with NEC showed significantly high risk of motor impairment (odds ratio 58.26, 95% confidence interval 7.80–435.12, p < 0.001). We found significantly increased mean diffusivity (MD) in the splenium of corpus callosum (sCC) (p = 0.001) and the left corticospinal tract (p = 0.001) in preterm infants with NEC. The sCC with increased MD showed a negative association with the BSID-III language (p = 0.025) and motor scores (p = 0.002) at 18 months of CA, implying the relevance of sCC integrity with later NDI.ConclusionThe white matter microstructure differed between preterm infants with and without NEC. The prognostic value of network parameters of sCC at TEA may provide better information for the early detection of NDI in preterm infants.

Infants at risk for physical disability may be identified by measures of postural control in supine

BackgroundEarly detection of delay or impairment in motor function is important to guide clinical management and inform prognosis during a critical window for the development of motor control in children. The purpose of this study was to investigate the ability of biomechanical measures of early postural control to distinguish infants with future impairment in motor control from their typically developing peers.MethodsWe recorded postural control from infants lying in supine in several conditions. We compared various center of pressure metrics between infants grouped by birth status (preterm and full term) and by future motor outcome (impaired motor control and typical motor control).ResultsOne of the seven postural control metrics—path length—was consistently different between groups for both group classifications and for the majority of conditions.ConclusionsQuantitative measures of early spontaneous infant movement may have promise to distinguish early in life between infants who are at risk for motor impairment or physical disability and those who will demonstrate typical motor control. Our observation that center of pressure path length may be a potential early marker of postural instability and motor control impairment needs further confirmation and further investigation to elucidate the responsible neuromotor mechanisms.ImpactThe key message of this article is that quantitative measures of infant postural control in supine may have promise to distinguish between infants who will demonstrate future motor impairment and those who will demonstrate typical motor control.One of seven postural control metrics—path length—was consistently different between groups.This metric may be an early marker of postural instability in infants at risk for physical disability.

Aging Effect on Manipulative Skills in Individuals With Down Syndrome

Deficits in motor performance have been well documented in individuals with Down syndrome (DS). However, only a few studies have focused on manipulative skills and older adults in this population. Given the associations between manipulative skills and daily living activities, more work is needed to examine the aging effect on individuals with DS. A total of 54 adults with DS participated in this study. The results indicated that older participants showed more lateralization than younger participants. They exhibited superior dominant hand preference compared to younger participants. In addition, participants with DS with high verbal ability had better performance in manual dexterity and handgrip force. Therefore, in the clinical setting, assessing mental age may help in identifying individuals with DS at a higher risk of motor impairment. Future work should examine additional determinants with a large sample size to understand the development of manipulative skills in individuals with DS. Furthermore, additional studies are needed to investigate the associations between mental age and other cognitive functions and motor performance in this population.

High Prevalence of Abnormal General Movements in Hospitalized Very Low Birth Weight Infants.

Abnormal general movements (GMs) are predictive of later risk of motor impairments in preterm infants. The goals of this study are to (1) describe the implementation of the GM assessment (GMA) in a neonatal intensive care unit (NICU) and (2) investigate the prevalence and evolution of abnormal GMs in very low birth weight (VLBW) infants. Observational study of GMs in VLBW infants (gestational age [GA] <32 weeks and/or birth weight [BW] <1,500 g) following GMA implementation in a level-IV NICU. All VLBW infants admitted between November 2017 and April 2019 were eligible for the GMA. Infants were excluded if they required high-frequency ventilation or if they could not be unbundled for video acquisition. GMAs were scored weekly by at least 2 GMA-certified providers. The GMA was performed in 121 VLBW infants with a mean (standard deviation [SD]) GA of 28.3 (2.6) and BW of 1,113 (400 g). Only 28% of infants had normal GMs on initial assessment (32.9 ± 2.7 weeks' GA), while 61 and 11% had poor repertoire and cramped-synchronized GMs, respectively. At NICU discharge (37.6 ± 3.4 weeks corrected GA), 45 and 21% of infants were classified as having poor repertoire and cramped-synchronized GMs, respectively. Most infants with cramped-synchronized GMs on initial assessment had persistent abnormal GMs at discharge. In contrast, only one infant with normal GMs on first assessment developed cramped-synchronized GMs. Abnormal GMs are common in VLBW infants, including a high prevalence of the more concerning cramped-synchronized movement pattern. The GMA can be successfully performed in VLBW infants. The GMA may be helpful in identifying infants at increased risk of later motor impairments, as well as assisting clinicians, in the stratification of infants who may benefit from additional brain imaging and/or an intensive hospital-based interventions. · Abnormal GMs are common in VLBW infants.. · Poor repertoire in the most prevalent pattern observed.. · Infants at risk for abnormal motor outcomes can be identified in the NICU..

Motor Impairment Increases in Children With Autism Spectrum Disorder as a Function of Social Communication, Cognitive and Functional Impairment, Repetitive Behavior Severity, and Comorbid Diagnoses: A SPARK Study Report.

Eighty-seven percent of a large sample of children with autism spectrum disorder (ASD) are at risk for motor impairment (Bhat, Physical Therapy, 2020, 100, 633-644). In spite of the high prevalence for motor impairment in children with ASD, it is not considered among the diagnostic criteria or specifiers within DSM-V. In this article, we analyzed the SPARK study dataset (n = 13,887) to examine associations between risk for motor impairment using the Developmental Coordination Disorder-Questionnaire (DCD-Q), social communication impairment using the Social Communication Questionnaire (SCQ), repetitive behavior severity using the Repetitive Behaviors Scale - Revised (RBS-R), and parent-reported categories of cognitive, functional, and language impairments. Upon including children with ASD with cognitive impairments, 88.2% of the SPARK sample was at risk for motor impairment. The relative risk ratio for motor impairment in children with ASD was 22.2 times greater compared to the general population and that risk further increased up to 6.2 with increasing social communication (5.7), functional (6.2), cognitive (3.8), and language (1.6) impairments as well as repetitive behavior severity (5.0). Additionally, the magnitude of risk for motor impairment (fine- and gross-motor) increased with increasing severity of all impairment types with medium to large effects. These findings highlight the multisystem nature of ASD, the need to recognize motor impairments as one of the diagnostic criteria or specifiers for ASD, and the need for appropriate motor screening and assessment of children with ASD. Interventions must address not only the social communication and cognitive/behavioral challenges of children with ASD but also their motor function and participation. LAY ABSTRACT: Eighty-eight percent of the SPARK sample of children with ASD were at risk for motor impairment. The relative risk for motor impairment was 22.2 times greater in children with ASD compared to the general population and the risk increased with more social communication, repetitive behavior, cognitive, and functional impairment. It is important to recognize motor impairments as one of the diagnostic criteria or specifiers for ASD and there is a need to administer appropriate motor screening, assessment, and interventions in children with ASD.

Is Motor Impairment in Autism Spectrum Disorder Distinct From Developmental Coordination Disorder? A Report From the SPARK Study.

Motor impairments are pervasive in Autism Spectrum Disorder (ASD); however, children with ASD rarely receive a dual diagnosis of Developmental Coordination Disorder (DCD). The Simons Foundation SPARK study engaged families affected by ASD through an online study. The DCD parent questionnaire (DCDQ) was used to assess the prevalence of a risk for motor impairment or DCD in children with ASD between 5 and 15years of age. This study utilizes parent reports from a large database of children with ASD. A total of 16,705 parents of children with ASD completed the DCDQ. We obtained our final SPARK dataset (n=11,814) after filtering out invalid data, using stronger cut-offs to confirm ASD traits, and excluding children with general neuromotor impairments/intellectual delays. We compared DCDQ total and subscale scores from the SPARK dataset with published norms for each age between 5 and 15years. The proportion of children with ASD at risk for a motor impairment was very high at 86.9%. Children with ASD did not outgrow their motor impairments and continued to present with a risk for DCD even into adolescence. Yet, only 31.6% of children were receiving physical therapy services. Our analysis of a large database of parent-reported outcomes using the DCDQ did not involve follow-up clinical assessments. Using a large sample of children with ASD, this study shows that a risk for motor impairment or DCD was present in most children with ASD and persists into adolescence; however, only a small proportion of children with ASD were receiving physical therapist interventions. A diagnosis of ASD must trigger motor screening, evaluations, and appropriate interventions by physical and occupational therapists to address the functional impairments of children with ASD while also positively impacting their social communication, cognition, and behavior. Using valid motor measures, future research must determine if motor impairment is a fundamental feature of ASD.

Diffusion tensor imaging is associated with motor outcomes of very preterm born children at 11 years of age.

Very preterm children born <32weeks of gestation are at risk for motor difficulties such as cerebral palsy and developmental coordination disorder. This study explores the association between diffusion tensor imaging metrics at term and motor outcomes at 11years of age. A cohort of 37 very preterm infants (mean gestational age 29 4/7, SD 2 0/7) born in 2004-2006 in Turku University Hospital underwent diffusion tensor imaging at term. A region of interest analysis of fractional anisotropy and mean diffusivity was performed. Motor outcomes at 11years of age were measured with the Movement Assessment Battery for Children - Second Edition. The diffusion metrics of the corpus callosum (genu P=.005, splenium P=.049), the left corona radiata (P=.035) and the right optic radiation (P=.017) were related to later motor performance. Mean diffusivity decreased and fractional anisotropy increased in proportion to the improving performance. The diffusion metrics of the genu and splenium of the corpus callosum, the left corona radiata and the right optic radiation at term were associated with motor skills at 11years of age. Diffusion tensor imaging should be further studied as a potential tool in recognising children at risk for motor impairment.

Comparing Standardized and Parent-Reported Motor Outcomes of Extremely Preterm Infants.

Extremely preterm infants are at increased risk of motor impairment. The Canadian Neonatal Follow-Up Network (CNFUN) afforded an opportunity to study the outcomes of extremely preterm children. The purpose of this study was to compare 18-month corrected age (CA) motor outcomes of extremely preterm infants with parent-reported functional outcomes at 3 years CA. CNFUN data of 1376 infants were used to conduct chi-square analyses to compare Bayley-III motor scores (composite, gross, and fine motor) at 18 months CA with parent-reported Ages and Stages Questionnaire motor scores (gross and fine motor) at 3 years CA. The correlation of motor scores at 18-months CA with parent-reported gross and fine motor scores at 3 years CA was also examined. We found that 1 in 5 infants scoring within or above the average range on the Bayley-III had parent-reported functional fine and gross motor difficulties at 3 years CA. Bayley-III scores were only moderately correlated with functional motor outcomes. Results of the study suggest that the Bayley-III at 18 months CA was able to detect the majority of infants with motor problems, but not all; therefore, ongoing follow-up of extremely preterm infants is required. The Bayley-III motor composite score has greater clinical utility compared to sub-scale scores.

Normative values of the motor competence assessment (MCA) from 3 to 23 years of age

ObjectivesGrowing evidence of the importance of motor competence for developing a healthy lifestyle has been established in the last decade. Nonetheless, no single instrument or observation tool have been able to fully measure this construct, particularly because most were built for the diagnosis of children in risk for motor impairment; are limited to a few years of the developmental span; lack objectivity in the assessment protocols; or do not include the locomotor, stability, and manipulative components. This led to the difficulty of comparing researches, and longitudinally follow children into adulthood. Recently, a novel proposal to assess motor competence was presented - the Motor Competence Assessment (MCA) - and this study aims to present the MCA normative data from 3-to-23 years. Design and methodsTwo thousand and eighty-seven participants (1102 boys) between 3 and 23 years of age were evaluated in the MCA (standing long jump, 10 m shuttle run, throwing velocity, kicking velocity, lateral jumps, shifting platforms). Results for each test were introduced in the LMS Chartmaker 2.3. The best model for test and sex was used, resulting in normative curves and percentile values. ResultsFinal norms showed a good fit to the instrument developmental expectations, allowing to differentiate and classify performances along the age interval. ConclusionsThe MCA age- and sex- normative values allow to assess motor competence from childhood to early adulthood. Future directions will include obtaining a total MCA score and the normative scores for the MCA components (stability, locomotion, object control), and to expand the norms to adulthood and old age.

The intercostal nerve as a target for diagnostic biopsy.

OBJECTIVE Peripheral nerve biopsy is a useful tool in diagnosing peripheral neuropathies. Sural and gracilis nerves have become the most common targets for nerve biopsy. However, the yield of sural nerve biopsy is limited in patients who have motor neuropathies, and gracilis nerve biopsy presents technical challenges and increased complications. The authors propose the intercostal nerve as an alternative motor nerve target for biopsy. METHODS A total of 4 patients with suspected peripheral neuropathies underwent intercostal nerve biopsy at the authors' institution. A rib interspace that is inferior to the pectoralis muscle and anterior to the anterior axillary line is selected for the procedure. Generally the lower intercostal nerves (i.e., T7-11) are targeted. An incision is made over the inferior aspect of the superior rib at the chosen interspace. Blunt dissection is carried down to the neurovascular bundle and the nerve is isolated, ligated, and cut to send for pathological examination. RESULTS The average operative time for all cases was 73 minutes, with average blood loss of 8 ml. Biopsy results from 1 patient exhibited axonopathy, and the other 3 patients demonstrated axonopathy with demyelination. There were no short- or long-term postoperative complications. None of the patients reported sensory or motor deficits related to the biopsy at 6 weeks postoperatively. CONCLUSIONS The intercostal nerve can be an alternative target for biopsy, especially in patients with predominantly motor neuropathies, due to its mixed sensory and motor fibers, straightforward anatomy, minimal risk of serious sensory deficits, and no risk of motor impairment.

Extremely preterm infants small for gestational age are at risk for motor impairment at 3 years corrected age

BackgroundFew studies have targeted psychomotor development and associated perinatal risk factors in Japanese very low birth weight (VLBW) infants who are severely small for gestational age (SGA). Design/subjectsA single-center study was conducted in 104 Japanese VLBW infants who were born preterm, due to maternal, umbilical cord, or placental abnormalities, between 2000 and 2007. Psychomotor development as a developmental quotient (DQ) was assessed using the Kyoto Scale of Psychological Development at 3years corrected age. Severely SGA was defined as birth weight or length below −2 standard deviation values of the mean values at the same gestation. VLBW infants were divided into 2 subgroups based on gestational age at birth: ⩾28weeks (n=64) and <28weeks (n=40). DQs of infants with severe SGA were compared with those of infants who were appropriate for gestational age (AGA). Factors associated with developmental disabilities in VLBW infants with severe SGA (n=23) were determined. ResultsIn the group born at ⩾28weeks gestation, infants with severe SGA had normal DQ values and did not significantly differ from those with AGA. However, in the group born at <28weeks gestation, severe SGA infants had significantly lower postural–motor DQ values than AGA infants. Gestational age <28weeks was an independent factor for low postural–motor DQ, regardless of the cause of severe SGA or pregnancy termination. ConclusionsExtremely preterm newborns with severe SGA are at risk of motor developmental disability at age 3years.

PO-0624 The Cost Of Disability And Improving The Condition Of Neonates With Hypoxic And Ischaemic Impairment Of The Central Nervous System

Background and aims Caring for a child with disability can be expensive not only for the family itself but also to society. Premature neonates are more likely to be re-hospitalised than babies born at full term and the healthcare costs in the first year are significantly higher for premature babies. The cost of caring for a disabled child is clearly immense. As a result it is important to try to find ways to prevent disabilities or improve the condition of neonates who are at a risk of developing disabilities. For this reason the Intensive Neonatal care unit at the regional hospital of Ruse has focused on an early physiotherapy intervention (EPI) program on neonates with hypoxic and ischaemic impairment of the central nervous system (CNS). Methods The study covers a period of 4 years and includes 172 randomised premature infants of different sexes who were placed in 2 groups (control and experimental). The placement in one of the two groups takes place after a conversation with the parents and informing them about the risk for motor impairments. Results Hammersmith neurodevelopment and motor development test that was performed to both groups of preterm neonates shows considerable improvement in the motor development to those neonates with EPI immediately after birth. Conclusion Neonate’s brain has a high plasticity after birth and great opportunities for recovery. As the EPI improves the condition of neonates at risk of development motor disabilities it can help reduce the cost of disability in the long run.

A crucial role of altered fractional anisotropy in motor problems of very preterm children

BackgroundVery preterm children (<32 weeks of gestation) are characterized by impaired white matter development as measured by fractional anisotropy (FA). This study investigates whether altered FA values underpin the widespread motor impairments and higher incidence of developmental coordination disorder (DCD) in very preterm children at school-age. MethodsThirty very preterm born children (mean (SD) age of 8.6 (0.3) years) and 47 term born controls (mean [SD] age 8.7 [0.5] years) participated. Motor development was measured using the Movement Assessment Battery for Children. A score below the 15th percentile was used as a research diagnosis of DCD. FA values, as measure of white matter abnormalities, were determined for 18 major white matter tracts, obtained using probabilistic diffusion tensor tractography. ResultsLarge-sized reductions in FA of the cingulum hippocampal tract right (d = 0.75, p = .003) and left (d = 0.76, p = .001), corticospinal tract right (d = 0.56, p = .02) and left (d = 0.65, p = .009), forceps major (d = 1.04, p < .001) and minor (d = 0.54, p = .02) were present in very preterms, in particular with a research diagnosis of DCD. Reduced FA values moderately to strongly related to motor impairments. A ROC curve for average FA, as calculated from tracts that significantly discriminated between very preterm children with and without a research diagnosis of DCD, showed an area under curve of 0.87 (95% CI 0.74–1.00, p = .001). ConclusionsThis study provides clear evidence that reduced FA values are strongly underpinning motor impairment and DCD in very preterm children at school-age. In addition, outcomes demonstrate that altered white matter FA values can potentially be used to discriminate between very preterm children at risk for motor impairments, although future studies are warranted.

Assessment of Developmental Coordination Disorder in Children Born With Extremely Low Birth Weights

There is no tool that is considered the “gold” standard for identifying children with developmental coordination disorder (DCD) and various techniques have been reported in the research literature. The aim of this study was to examine the prevalence of DCD in a cohort of extremely low birth weight (ELBW; birth weight ≤ 1,000g) children at age 5 years using various methods including standardized motor assessment measures, an established clinic protocol, and a parent report. We also examined the association between selected neonatal risk factors and severity of the motor impairment. Four methods were used to assess motor functioning: (1) the Movement Assessment Battery for Children (Movement ABC); (2) a motor assessment battery, which included the Movement ABC, the Beery-Buktenica Developmental Test of Visual Motor Integration, and the Developmental Test of Visual Perception–2; (3) a Perinatal Follow-up Clinic protocol, which included the Geometric Design and the Mazes subtests of the Wechsler Preschool and Primary Scale of Intelligence–Revised, the Fine and Gross Motor subscales of the Child Development Inventory, and a pediatric neuromotor exam; and (4) a parent completed questionnaire (i.e., Developmental Coordination Disorder Questionnaire (DCDQ)). The prevalence of motor impairment in ELBW children was 64% on the Movement ABC, 67% on the motor assessment battery, 66% on the Perinatal Follow-up Clinic protocol, and 26% on the DCDQ. Sensitivity ranged from 36% to 100% and specificity from 65% to 92% using the Movement ABC as the reference standard. Neonatal risk factors associated with increased severity of motor impairment were bronchopulmonary dysplasia, postnatal steroids, and increasing gestational age. Children with birth weights ≤1,000 g are at considerable risk for motor impairment; therefore, developmental evaluations should include an assessment of motor functions. A standardized motor assessment test such as the Movement ABC appears to be the most effective and efficient means of identifying motor impairment in this high-risk population.

Concerns over babies facing risk of motor impairment

Concerns over babies facing risk of motor impairment

Interrater Reliability of the Movement Assessment Battery for Children

The Movement Assessment Battery for Children (M-ABC) is a widely used, standardized assessment of motor performance in children. The total score obtained on this test often is used to identify children who are either definitely impaired or at risk for motor impairment. The purpose of this study was to determine the interrater reliability of data for the M-ABC when scored by pediatric physical therapists working in routine clinical settings. For 9 children who were referred to clinical settings for an assessment of possible movement difficulties, performance on the appropriate age band of the M-ABC was videotaped. The 9 children, one at each age from 4 through 12 years, represented all ages covered by the test. The videotaped performances were rated according to the test instructions by 131 pediatric physical therapists with a range of experience and by an expert rater who developed the Dutch version of the test. The average agreement between therapists in their classification of the children was very high. The kappa coefficients for the 9 videos ranged from .95 to 1.00. Errors made by the therapists could be classified as those that might be common to all tests and those that are specific to the M-ABC.

Diuretic therapy for newborn infants with posthemorrhagic ventricular dilatation.

Intraventricular hemorrhage remains a serious complication of premature birth and post hemorrhagic hydrocephalus still has no satisfactory treatment. Acetazolamide and furosemide, which both reduce the production of cerebrospinal fluid, have been suggested as non-invasive therapies to reduce hydrocephalus and the need for ventriculo-peritoneal (V-P) shunting. The aim of this review was to determine whether the use of acetazolamide and furosemide improves outcome, especially shunt dependence, in infants developing post-hemorrhagic ventricular dilatation. The standard search strategy of the Cochrane Collaboration was used. Randomised, or quasi-randomised trials, of acetazolamide and/or furosemide compared with standard therapy in infants with IVH or post-hemorrhagic ventricular dilatation Data were extracted independently by each author and were analysed by the standard methods of the Cochrane Collaboration using relative risk (RR) and risk difference (RD), a fixed effect model and sensitivity analyses where appropriate. There were two eligible trials: one randomized 16 infants and the other, 177. Neither showed a decreased risk for V-P shunt or for V-P shunt or death associated with acetazolamide and furosemide therapy. The larger trial showed that acetazolamide and furosemide treatment resulted in a borderline increase in the risk for motor impairment at one year (RR 1.27, CI 1.02 to 1.58; RD 0.16, CI 0.02 to 0.31), but did not significantly affect the risk for the combined outcome of delay, disability or motor impairment among survivors, or the risk of the combined outcome of death, delay, disability or impairment at one year. The larger trial showed that diuretic treatment increased the risk for nephrocalcinosis (RR 5.31, CI 1.90 to 14.84; RD 0.19, CI 0.09 to 0.29); meta-analysis confirmed this result. Acetazolamide and furosemide therapy is neither effective nor safe in treating post hemorrhagic ventricular dilatation. Acetazolamide and furosemide cannot be recommended as therapy for post hemorrhagic hydrocephalus.