Developmental Medicine and Child Neurology最新文献

Cerebral palsy (CP) is a widely used descriptive label for a spectrum of motor impairments caused by non-progressive brain injury or malformation during early development. Recent advances in genetics, inflammation research, and neurophysiology have refined scientific understanding of CP, and studies in diverse global contexts, including low- and middle-income countries, have broadened knowledge of its clinical presentation. Shifting societal perspectives, particularly those informed by individuals with lived experience, have challenged ableist assumptions and promoted conceptual frameworks that are more inclusive. Growing recognition of the lifelong needs of adults with CP has further emphasized the necessity of appropriate services across the lifespan. This manuscript presents an updated description of CP, developed through a collaborative, multidisciplinary process integrating stakeholders' perspectives. A comprehensive stakeholder analysis and mapping strategy ensured wide representation, including individuals with CP, families, clinicians, researchers, and advocacy organizations. Data were collected using surveys, interviews, focus groups, and workshops, enabling a global dialogue that combined lived experience with clinical and scientific expertise. An annotation of 26 specific terms of the updated clinical description supports a clearer and more inclusive shared understanding of CP. We also present a more accessible plain-language version of the description, as well as a single-sentence summary. The updated description is intended as a framework to guide clinical practice, research, and policy, to advance the care, participation, and inclusion of individuals with CP.

Aim: To explore longitudinal associations between ophthalmological outcome and development of visual perception, fine motor precision, and visual-motor integration (VMI) in children born very preterm (gestational age <32 weeks).

Method: This was a prospective longitudinal cohort study of 113 children (51 females, 62 males) born very preterm. Visual acuity, low-contrast visual acuity, stereopsis, and strabismus were investigated at 2 years 6 months (n = 98), 6 years 6 months (n = 84), and 12 years (n = 59). VMI was assessed at 6 years 6 months and 12 years, and visual perception and fine motor precision at 12 years, with the Beery-Buktenica Developmental Test of Visual-Motor Integration. Controls born at term were assessed at 6 years 6 months (n = 64) and 12 years (n = 46).

Results: For children born preterm, subnormal visual acuity at 2 years 6 months was related to both poorer VMI and fine motor precision at 12 years. Subnormal visual acuity, strabismus, and stereopsis at 6 years 6 months were also related to poorer VMI, visuo-perceptual, and fine motor measures at 12 years. These associations were not present in controls born at term.

Interpretation: Subnormal ophthalmological function at 2 years 6 months and 6 years 6 months in children born very preterm is related to poorer performance on VMI, visuo-perceptual, and fine motor precision tasks at 12 years, indicating that the quality of visual input interacts with developing visual-motor abilities. The results of this study provide new insights on the relationship between ophthalmological function and neurodevelopment after preterm birth.

Aim: To assess the effect of the augmented reality application called Minidocs on pain reduction during botulinum neurotoxin A (BoNT-A) injections in children with cerebral palsy (CP).

Method: Children with CP aged 3 to 8 years undergoing BoNT-A injection were randomized to usual pain management alone (n = 41) or combined with Minidocs (n = 39). Minidocs is an augmented reality application on a digital device offering several games including active distraction, hypnotic suggestion, and counter-aggression features. The primary outcome was the child's pain during BoNT-A injection, combining patient-reported (Faces Pain Scale [FPS]) and observer-reported (Face, Legs, Activity, Cry, Consolability scale [FLACC]) outcomes. Secondary outcomes included anxiety of children (Modified Yale Preoperative Anxiety Scale) and parents (State-Trait Anxiety Inventory Form Y-1), and satisfaction with Minidocs.

Results: In total, 14 out of 41 (34.1%) children in the control group and 7 out of 39 (17.9%) children in the experimental group experienced pain (i.e. FPS or FLACC scores ≥4). The difference between groups was not statistically significant (odds ratio 0.36; 95% confidence interval 0.11-1.16; p = 0.087). Changes in anxiety scores from before to after injection did not differ between groups. Satisfaction with the use of Minidocs was high.

Interpretation: This study did not demonstrate the benefit of augmented reality on pain reduction. The counter-aggression feature is an innovation of Minidocs worth exploring. Further studies are needed to identify profiles of children who respond to non-drug therapies.

Aim: To expand the scope of the Hand Assessment for Infants (HAI) by validating its internal scale structure and reliability in infants with a corrected age of 3 to 12 months who are at risk of bilateral or unilateral cerebral palsy (CP).

Method: This test-validation study included 274 HAI assessments collected from 221 infants (mean age = 7 months, SD = 2.4 months, 132 males) at risk of unilateral (n = 123) or bilateral (n = 98) CP. Each assessment was scored on 17 HAI items (12 unimanual and five bimanual) and analysed using the Rasch measurement model.

Results: Strong internal scale validity and person and item reliability were found for the HAI items when analysed separately for infants at risk of unilateral and bilateral CP. Logit measures for both scales were linked to a common reference frame, allowing comparable overall bimanual performance measures (HAI unit) while maintaining distinct item difficulty hierarchies.

Interpretation: The HAI provides valid and reliable measures of hand use in infants at risk of bilateral and unilateral CP regardless of the severity of manual impairments. By linking the scales, the HAI unit provides a comparable measure of bimanual performance across CP subtypes. Thus, the subtype of CP does not need to be determined before data collection.