Relación entre la adquisición del gateo y la marcha independiente en el niño de alto riesgo en seguimiento / Relationship between gait acquisition and independent gait in the high-risk child in follow-up

Resumen Introducción: El gateo representa la primera forma de locomoción autónoma. Se han mencionado las implicaciones de la adquisición del gateo para lograr la marcha independiente y el control motor en el niño, pero son pocos los estudios relacionados con el gateo y sus efectos en el niño de alto riesgo biológico. Por eso se intentó conocer la relación entre la adquisición del gateo y la marcha independiente en una población de niños nacidos de alto riesgo en un programa de seguimiento pediátrico. Material y métodos: Estudio observacional, retrospectivo y descriptivo de una cohorte de niños de alto riesgo que acuden al seguimiento pediátrico, en el cual se revisó el periodo de adquisición del patrón de gateo y la marcha independiente. Resultados: Se integraron cuatro grupos: gateo normal, gateo limítrofe, gateo con retraso y gateo nulo. Se estudió a 558 lactantes; los grupos se integraron con gateo normal, 238 niños; gateo limítrofe, 96 lactantes; retraso en la adquisición del gateo, 207 niños; y gateo nulo, 17 niños. Por género, las niñas gatean mejor, con peso y edad gestacional mayores y predominio en los gateadores. La escala de Bayley señala mejores puntuaciones para los gateadores. En los niños con gateo normal, la marcha independiente se adquirió en el periodo normal a diferencia del grupo con retraso en el gateo en el cual la marcha independiente apareció con retraso. Conclusiones: En este estudio se identificó una relación entre la edad de inicio del gateo con la edad de adquisición de la marcha independiente, con mejor evolución en los niños gateadores.

Abstract Background: Crawling represents the first form of autonomous human locomotion. Much has been said about the implications that an adequate acquisition of crawling has on development in order to achieve independent gait in the short term and the child's motor control in the long term. There are few studies related to crawling and its implications in children who were high biologic risk newborns. Therefore, we wanted to know the relation between crawling acquisition and independent gait in a population of children who were high risk at birth in our Pediatric Follow up clinic. Material and Methods: An observational, retrospective, and analytical study of a cohort of children who were high risk at birth, and attended our pediatric follow-up clinic was done. The period between crawling acquisition and independent gait was reviewed. Results: 4 groups were integrated; normal crawling, borderline crawling, delayed crawling and null crawling. 558 infants were studied; the groups were integrated by: normal crawling 238 children; borderline crawling with 96 infants; delayed crawling with 207 children and null crawling with 17 children. By gender distribution, girls achieved better crawling. Weight and higher gestational age predominated in children with normal crawling. Crawlers had the best scores in the Bayley Scale. In children with normal crawling, independent gait was acquired within the normal period unlike the group with delay in crawling where independent gait was behind. Conclusions: In this study, we found a relation between the age of onset of crawling with the age of acquisition of the independent gait, with better skill in children who crawled.

Differences in walking attainment ages between low-risk preterm and healthy full-term infants / Diferenças na idade de aquisição da marcha entre lactentes pré-termo de baixo risco e a termo saudáveis

OBJECTIVE: To compare gross motor development of preterm infants (PT) without cerebral palsy with healthy full-term (FT) infants, according to Alberta Infant Motor Scale (AIMS); to compare the age of walking between PT and FT; and whether the age of walking in PT is affected by neonatal variables. METHODS: Prospective study compared monthly 101 PT and 52 FT, from the first visit, until all AIMS items had been observed. Results: Mean scores were similarity in their progression, except from the eighth to tenth months. FT infants were faster in walking attainment than PT. Birth weight and length and duration of neonatal nursery stay were related to walking delay. CONCLUSION: Gross motor development between PT and FT were similar, except from the eighth to tenth months of age. PT walked later than FT infants and predictive variables were birth weight and length, and duration of neonatal intensive unit stay.

OBJETIVO: Comparar o desenvolvimento motor de lactentes pré-termo sem paralisia cerebral (PT) com lactentes normais nascidos a termo (T), de acordo com Escala Motora Infantil de Alberta (AIMS); comparar idade da marcha entre PT e T e se a idade da marcha em PT é passível de ser afetada. MÉTODOS: Estudo prospectivo com 101 PT e 52 T, seguidos mensalmente até que todos os itens da AIMS tivessem sido observados. Resultados: Os escores médios apresentaram semelhanças entre os grupos, com exceção do oitavo ao décimo meses. Os lactentes T iniciaram marcha antes dos PT. Peso, estatura ao nascimento e tempo de internação na unidade de terapia intensiva neonatal (UTIN) foram preditivos. CONCLUSÃO: O desenvolvimento motor entre PT e T foi semelhante, exceto entre o oitavo e o décimo meses de idade. PT andaram mais tardiamente e variáveis preditivas foram peso, estatura ao nascimento e o tempo de permanência na UTIN.

'Confiabilidad interevaluador' de la Escala Motora Infantil de Alberta en niños de término y pretérmino de la provincia de Talca - Chile / 'Interrater reliability' of Alberta Infant Motor Scale in term and preterm born infants between 10 to 16 months age from Talca province - Chile / 'Confiabilidade inter-avaliador' da escala motora infantil de alberta em crianças de termo e pré-termo na província de talca, Chile

Objetivo: Examinar la 'confiabilidad interevaluador' de la Escala Motora Infantil del Alberta (AIMS) en infantes nacidos de término (NT) y pretérmino (NPT) entre 10 y 16 meses de edad, pertenecientes a la provincia de Talca, en la Región del Maule - Chile. Sujetos: 115 niños entre 10 y 16 meses de edad fueron incorporados al estudio; 95 fueron NT atendidos en los consultorios de la comuna de Talca, y 20 fueron NPT pertenecientes al Programa de Seguimiento de Prematuros del Hospital Regional de Talca. Métodos: El comportamiento motor de cada niño fue filmado y posteriormente evaluado por dos observadores entrenados que utilizaron la AIMS. Se obtuvo el puntaje total de la AIMS al igual que de las subescalas prono, supino, sedente y bípedo. Para el análisis de la 'confiabilidad interevaluador' se usó el Coeficiente de Correlación Intraclase (ICC), el Error Estándar de la Medición (EEM) y Límites de Acuerdo 95%. Resultados: Los ICC para los puntajes totales fueron mayores a 0.94 (p<0.0002) para los NT y NPT. El EEM de los puntajes totales fue menor a 3.1 puntos, mayor a lo encontrado por estudios similares. Los Límites de Acuerdo 95% fueron de + 5.3 a -4.1 puntos y + 7.7 a -3.9 puntos en NT y NPT, respectivamente, revelando 'concordancia interevaluador'. Conclusión: La AIMS mostró adecuados niveles de 'confiabilidad interevaluador' al ser aplicada en niños chilenos NT y NPT de 10 a 16 meses.

Purpose: To examine the 'interrater reliability' of the Alberta Infant Motor Scale (AIMS) in term and preterm born infants between 10 to 16 months age from Talca province, Maule Region - Chile. Subjects: 115 infants between 10 to 16 months age were incorporated to the study; 95 term born infants were attended in the local Health Centre in Talca City, and 20 preterm infants belonged to the Premature Infants Follow-Up Programme of Talca Regional Hospital. Methods: The motor behaviour of each infant was recorded and later it was assessed by two trained assessors using AIMS. It was obtained the total AIMS' score and also from prone, supine, seated, and stand subscales. For 'interrater reliability' analysis it was used the Intraclass Coefficient of Correlation (ICC), the Standard Error of Measurement (SEM) and 95% limits of agreement. Results: The obtained ICC for the total scores AIMS were major than 0.94 (p<0.0002) for term and preterm born infants. The SEM of total scores was less than 3.1 points, higher than what was found in other similar studies. The 95% limits of agreement were +5.3 to -4.1 points and +7.7 to -3.9 points in term and preterm born, respectively, revealing 'interrater agreement'. Conclusion: The AIMS showed adequate 'interrater reliable' levels when was applied in Chilean term and preterm born from 10 to 16 month's age.

Objetivo: Examinar a "confiabilidade inter-avaliador" da Escala Motora Infantil de Alberta (AIMS) em infantes nascidos de termo (NT) e pré-termo (NPT) entre 10 e 16 meses de idade, pertencentes à província de Talca, na Região de Maule, Chile. Indivíduos: 115 crianças entre 10 e 16 meses de idade foram incorporadas ao estudo; 95 foram NT atendidos nos consultórios da comuna de Talca, e 20 foram NPT pertencentes ao Programa de Seguimento de Prematuros do Hospital Regional de Talca. Métodos: o comportamento motor de cada criança foi filmado e posteriormente avaliado, pelos observadores preparados, utilizando a AIMS. Obteve-se a pontuação total da AIMS ao igual que das sub-escalas prono, supino, sedente y bípede. Para a análise da "confiabilidade interavaliador" se usou e Coeficiente de Correlação Intraclasse (ICC), o Erro Standard da Medição (EEM) e Limites de Acordo 95%. Resultados: Os ICC para as pontuações totais foram maiores a 0,94 (p<0.0002) para os NT e NPT. O EEM das pontuações totais foi menor a 3.1 pontos, maior ao encontrado por estudos similares. Os Limites de Acordo 95% foram de +5.3 a -4.1 pontos e + 7.7 a -3,9 pontos em NT e NPT, respectivamente, revelando concordância inter-avaliador. Conclusão: a AIMS mostrou adequados níveis de "confiabilidade inter-avaliador" ao ser aplicada em crianças chilenas NT e NPT de 10 a 16 meses.