Correlation between fractional anisotropy and motor outcomes in one-year-old infants with periventricular brain injury.

PURPOSE: To determine whether motor outcomes of an exercise intervention beginning at 2 months corrected age (CA) in children with periventricular brain injury (PBI) are correlated with fractional anisotropy (FA) measures derived from diffusion tensor imaging (DTI) at 12 months CA. MATERIALS AND METHODS: DTI was performed in eight infants with PBI who were randomly assigned to kicking and treadmill stepping exercise or a no-training condition. Development was assessed using the Alberta Infant Motor Scale (AIMS) and the Gross Motor Function Classification System (GMFCS). FA values were derived from regions of interest (ROIs) in the middle third of the posterior limb of the internal capsule (PLIC) and the posterior thalamic radiation (PTR). RESULTS: Significant correlations were observed between motor development and FA measures. For PLIC, the correlation coefficients were 0.82 between FA and AIMS, and -0.92 between FA and GMFCS, while for PTR the corresponding correlation coefficients were 0.73 and -0.80, respectively. CONCLUSION: Results of this study suggest that quantitative evaluation of white matter tracts using DTI at 12 months CA may be useful for assessment of brain plasticity in children.

Effects on motor development of kicking and stepping exercise in preterm infants with periventricular brain injury: a pilot study.

BACKGROUND: Preterm infants with periventricular brain injury (PBI) have a high incidence of atypical development and leg movements. OBJECTIVE: Determine whether kicking and treadmill stepping intervention beginning at 2 months corrected age (CA) in children with PBI improves motor function at 12 months CA when compared with control subjects. METHOD: In a multi-center pilot study for a controlled clinical trial, sixteen infants with PBI were randomly assigned to home exercise consisting of kicking and treadmill stepping or a no-training control condition. Development was assessed at 2, 4, 6, 10, and 12 months CA with the Alberta Infant Motor Scale (AIMS). At 12 months children were classified as normal, delayed, or with cerebral palsy (CP). RESULTS: At 12 months CA 3 of 7 (43%) of the exercise group children walked alone or with one hand held versus 1 of 9 (11%) in the control group (p=0.262), but no significant differences in AIMS scores were found at any age. Half of the subjects had CP or delay; the outcomes of these infants were not improved by exercise. Compliance with the home program was lower than requested and may have affected results. CONCLUSION: Although not statistically significant with a small sample size, self-produced kicking and treadmill exercise may lower age at walking in infants with normal development following PBI, but improvements of the protocol to increase and document compliance are needed before a larger study is implemented.

Predicting motor outcome at preschool age for infants tested at 7, 30, 60, and 90 days after term age using the Test of Infant Motor Performance.

BACKGROUND AND PURPOSE: Accurate and diagnostic measures are central to early identification and intervention with infants who are at risk for developmental delays or disabilities. The purpose of this study was to examine (1) the ability of infants' Test of Infant Motor Performance (TIMP) scores at 7, 30, 60 and 90 days after term age to predict motor development at preschool age and (2) the contribution of the home environment and medical risk to the prediction. SUBJECTS AND METHODS: Sixty-one children from an original cohort of 90 infants who were assessed weekly with the TIMP, between 34 weeks gestational age and 4 months after term age, participated in this follow-up study. The Peabody Developmental Motor Scales, 2nd edition (PDMS-2), were administered to the children at the mean age of 57 months (SD=4.8 months). The quality and quantity of the home environment also were assessed at this age using the Early Childhood Home Observation for Measurement of the Environment (EC-HOME). Pearson product moment correlation coefficients, multiple regression, sensitivity and specificity, and positive and negative predictive values were used to assess the relationship among the TIMP, HOME, medical risk, and PDMS-2 scores. RESULTS: The correlation coefficients between the TIMP and PDMS-2 scores were statistically significant for all ages except at 7 days. The highest correlation coefficient was at 90 days (r=.69, P=.001). The TIMP scores at 30, 60, and 90 days after term; medical risk scores; and EC-HOME scores explained 24%, 23%, and 52% of the variance in the PDMS-2 scores, respectively. The TIMP score at 90 days after term was the most significant contributor to the prediction. The TIMP cutoff score of -0.5 standard deviation below the mean correctly classified 80%, 79%, and 87% of the children using a cutoff score of -2 standard deviations on the PDMS-2 at 30, 60, and 90 days, respectively. DISCUSSION AND CONCLUSION: The results compare favorably with those of developmental tests administered to infants at 6 months of age or older. These findings underscore the need for age-specific test values and developmental surveillance of infants before making referrals.