Developmental Medicine and Child Neurology最新文献

Cerebral palsy (CP) is a movement disorder caused by a disruption in early brain development. CP affects 1 in 1000 children in high-income countries, meaning it is the most common disability of childhood. The earlier CP is diagnosed, the better, because then the brain can benefit from therapies during early developmental windows. The challenge is that many symptoms of CP don't become obvious until 6 to 12 months, when children are moving more purposefully. Ideally, CP would be diagnosed before 6 months to enable early specialized therapies. Such early diagnosis is possible when babies have conditions known to increase the risk of CP, such as being born very preterm, or having birth asphyxia.

To detect those with more subtle risk, a CP prediction tool was built using the Canadian CP Registry compared to typically developing controls, to make a single number score to represent a term-born baby's risk of CP based on pregnancy and birth risk factors. Unfortunately, 28% of the babies with CP fell into the ‘normal’ score range. The goal of the present study was to compare the babies with a ‘normal’ score and no newborn symptoms with those babies who would be detected due to high score or symptoms.

We found that in over 700 term-born children with CP, 25% had ‘undetectable’ newborn risk. The ‘undetectable’ group was more likely to be female, have problems with only half their body, be more able to walk, and be more able to talk than those children with ‘detectable’ CP risk. This study shows that 1/4 of term-born children with CP lack clear risk factors during pregnancy or as newborns, and that the first symptom is likely to be asymmetry in their hand use starting at 2 to 3 months of age. Therefore, any baby with asymmetry of their hands should be promptly referred for investigation for CP.

Aim: To seek consensus on recommendations for the delivery of services to disabled children in England during future emergencies.

Method: Candidate recommendations were drafted based on our related mapping review and qualitative research related to experiences during the COVID-19 pandemic. Iterative workshops with professionals and parent carers helped to refine the recommendations. A Delphi survey, rating the importance of each recommendation, was conducted with (1) parent carers of disabled children, (2) disabled young people aged 8 to 19 years, and (3) health, education, and social care professionals. A consensus meeting was convened online to discuss the findings and ratify the recommendations.

Results: Twenty-eight recommendations were included in the Delphi survey. There were 141 participants in round 1 and 91 in round 2. Seven recommendations reached the agreed consensus criteria for being critical across all stakeholder groups, while 21 recommendations did not reach consensus across all groups. Fourteen participants ratified 23 recommendations, which when aggregated and refined further produced our final 19 recommendations.

Interpretation: Reductions in services for disabled children and their families during the COVID-19 pandemic had serious and lasting consequences. This study enabled parent carers, disabled young people, and health, education, and social care professionals to agree recommendations on services for disabled children during future emergencies.

Early recognition of a developmental concern or disability is crucial for children and their families. This scoping review provides evidence-based recommendations on which tools are best to use for the early detection of developmental concerns or disability in young children (birth to 5 years 11 months) available for use in primary health care and the community.

Tools which screen or assess different domains of development (e.g. cognition, motor, neurological, communication and language, sensory processing, social–emotional, play) or multiple domains of development were examined. Tools which assess or diagnose cerebral palsy, attention-deficit/hyperactivity disorder, autism spectrum disorder, developmental coordination disorder, and fetal alcohol spectrum disorder were also examined.

Eighty-six systematic reviews and six clinical practice guidelines guided the identification of tools. A total of 246 tools were identified. After critical evaluation, 67 tools were included in the recommendations.

Multi-domain tools are those which can be used to screen or assess a child across multiple developmental domains. There was extensive psychometric evidence for the Ages & Stages Questionnaire, Third Edition (ASQ-3). The ASQ-3 aims to identify children with concerns across cognition, motor, communication, and personal-social domains from 1 month through to 5 years 6 months (1–66 months) of age. Other multi-domain screening tools include the Parents' Evaluation of Developmental Status and the Parent Report of Children's Abilities-Revised which is a norm-referenced assessment of cognitive and language development at 2 years of age. Three multi-domain developmental assessment tools were identified with good to excellent psychometric properties: the Bayley Scales of Infant and Toddler Development, Third Edition, the Battelle Developmental Inventory, Second Edition, and the Mullen Scales of Early Learning.

Image generated by ChatGPT when the authors described the aim of the review and asked for an image which represented it.

This study looked at how well an autism screener, the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F), identified autism likelihood in toddlers who were born preterm compared to those born full term. The study also examined rates of autism diagnoses following screening in children born preterm.

A total of 9725 toddlers were screened using the M-CHAT-R/F, a parent questionnaire, at 15, 18, or 24 months of age during well visit check-ups. Toddlers were assigned to one of four groups based on how early they were born (extremely preterm, very preterm, moderately preterm, or full term). Those who screened positive were invited for diagnostic evaluation.

Results showed that children born extremely preterm had the highest rate of positive autism screenings (51.35%), whereas those born at term had the lowest rate (6.95%). Children attended the evaluations at similar rates across the preterm categories. Those who were born extremely preterm were most likely to receive an autism diagnosis (16.05%), followed by those born very preterm (2.00%), moderately preterm (2.89%), and full term (1.49%).

We evaluated the natural history of cerebral visual impairment (CVI) in children with cerebral palsy (CP) using a longitudinal study design. We also wanted to explore which early visual signs and symptoms were associated with cognitive visual disorders (CVDs) later at school age.

A sample of 51 participants diagnosed with CP and CVI were enrolled. They underwent a neurovisual evaluation (ophthalmological, oculomotor, and basic visual functions) at three time points: T0 (6–35 months old), T1 (3–5 years old), and T2 (≥6 years old). Children at school-age (range 72–144 months) also performed a cognitive-visual evaluation. A multidisciplinary team performed the neurovisual evaluation.

Ophthalmological deficits remained stable over time, except for ocular fundus abnormalities and strabismus whose frequencies increased with age. Conversely, fixation, smooth pursuit, and saccades deficits, as well as visual acuity, contrast sensitivity, and visual field all improved over time. Twenty children were also found to have a cognitive visual impairment at T2. The presence of early oculomotor dysfunctions appeared to be associated with CVD at school age.

Aim: To evaluate negative effects on oral motor function after concurrent submandibular and parotid (four-gland) botulinum neurotoxin A (BoNT-A) injections as a treatment for paediatric drooling.

Method: This was a retrospective cohort study of 125 children (median age 7 years 7 months [interquartile range 4 years 5 months]) with developmental disabilities, including cerebral palsy, treated with four-gland injections. Most children (90.4%) were previously exposed to submandibular injections. Frequency, severity, and duration of negative effects on oral motor function (i.e. saliva swallowing, eating, drinking, articulation) were evaluated and compared to a reference cohort treated with submandibular injections.

Results: Negative effects on oral motor function were reported in 45 children (36.0%), predominantly manifesting as eating-related problems (64.4%). Most negative effects (62.2%) were classified as mild and resolved within 4-weeks post-injunction (53.3%). Compared to the reference cohort, frequency (36.0% vs 33.0%) and duration (53.3% vs 53.6% resolving within 4 weeks) of negative effects were comparable, although problems were more often moderately severe (33.3% vs 10.1%).

Interpretation: While negative effects on oral motor function were relatively common after four-gland BoNT-A injections, most problems were mild and resolved promptly. No substantial differences to a reference cohort treated with submandibular injections were observed, although further research should establish the generalizability of these findings in a treatment-naive population. Nevertheless, when submandibular injections prove ineffective, clinicians can confidently consider four-gland injections.

Speech-language skills predict independent living, education, social participation, and employment opportunities. Individuals with complex communication needs often rely on augmentative and alternative communication (AAC) devices to support communication, language, and literacy development. Early and continuous provision of speech-language pathology (SLP) services is essential for assessments and tailored interventions. Access to SLP services can be challenged by numerous barriers, including the more recent COVID-19 pandemic that urged the shift to remote delivery of care, i.e. teleinterventions. Synthesized insights on the provision of tele-AAC interventions were lacking, thus making this shift less straightforward for clinical practice and families.

To address this gap, this study reviewed the existing evidence on the efficacy of tele-AAC interventions provided remotely by clinicians or researchers. Key aspects include intervention setup, AAC technology, outcome measures, procedural modifications, satisfaction, and risk of bias. The review included six studies with 25 participants, varying in diagnosis and age. Two studies used real-time (active) consultation between senior clinicians and pre-professionals, two conducted functional communication training for children with autism, one explored tele-brain–computer interface and one compared tele-AAC with in-person interventions. Outcome measures included independent use of an AAC device, increased number of produced phrases, and successful replacement of idiosyncratic communication with AAC.

Tele-AAC interventions, regardless of delivery method, appear feasible and as effective as in-person interventions across different ages and diagnoses. Functional assessments before and procedural modifications during the intervention are essential for a tailored approach that considers individual needs and capabilities. Caregivers play a critical role in successfully implementing tele-AAC interventions, thus, pre-intervention training is important to ensure high fidelity and minimize burden.

Although with great potential to expand the reach and provide continuity of care, tele-AAC interventions are scarce, with weak to moderate quality and a high risk of bias. Future research with a larger, diverse sample and stronger methodology is recommended.

The survival rate of infants who are born preterm has improved with advances in prenatal and neonatal care. However, infants who are born too early and who require neonatal intensive care are at high risk of experiencing developmental delays starting in infancy. A common developmental delay includes difficulty with breast/bottle feeding. Recognizing the pivotal role of early postnatal experiences in shaping lifelong developmental trajectories, several early interventions approaches have emerged, among them are sensorimotor programs and parental engagement strategies. Both approaches are aimed at optimizing the developmental outcomes in infants born preterm, however there is very limited evidence on the effect of parent-administered sensorimotor interventions (PASI) on oral feeding outcomes for infants born preterm to warrant implementation into NICUs standard care practices. The objective of this study is to evaluate the effect of a PASI program on the feeding outcomes of infants born preterm during their stay in the neonatal intensive care unit (NICU).

A randomized clinical study was conducted with 94 infants initially enrolled and randomly assigned to an experimental or a control group. Infants in the experimental group received a PASI program consisting of tactile input to oral structures, trunk/limbs, and non-nutritive sucking for 15-minutes, once a day, for 10 days. Infants in the control group received standard care. Outcomes included attainment of complete oral feeds, occurrence of direct breastfeeding at hospital discharge, and motor function assessed using the Test of Infant Motor Performances (TIMP). A total of 80 infants completed the study. Infants in the experimental group achieved complete oral feeds 4 days sooner, and a greater number of them received direct breastfeeds than controls. Infants in both groups had equivalent motor functions scores on the TIMP.

Cerebral palsy (CP) is a condition that makes it hard for people to move and control their muscles. More than 90% of children with CP grow up to be adults. However, many adults with CP get tired easily, feel pain, and have trouble moving around as they get older. They are also more likely to have other health problems like diabetes, heart issues, stroke, and weak bones, so they need regular healthcare to help manage their CP and other health problems. Previous research has shown that adults with CP often have many health problems and use different health services. But there has not been much research on how well they can get this help in Ireland.

In our study, we wanted to find out how adults with CP use health services and what their experiences were like. We talked to 21 adults with CP, seven people who support them, and 15 healthcare providers who work with adults with CP. Out of the 21 adults with CP we interviewed, most were women (67%) and most used wheelchairs (67%). We used a method called thematic analysis to look at all their experiences.