Movement Assessment of Children (MAC): validity, reliability, stability and sensitivity to change in typically developing children.

AIM: The purpose of this study was to establish the validity, reliability, stability and sensitivity to change of the family-centred Movement Assessment of Children (MAC) in typically developing infants/toddlers from 2 months (1 month 16 days) to 2 years (24 months 15 days) of age. BACKGROUND: Assessment of infant/toddler motor development is critical so that infants and toddlers who are at-risk for developmental delay or whose functional motor development is delayed can be monitored and receive therapy to improve their developmental outcomes. Infants/toddlers are thought to be more responsive during the MAC assessment because parents and siblings participate and elicit responses. METHODS: Two hundred seventy six children and 405 assessments contributed to the establishment of age-related parameters for typically developing infants and toddlers on the MAC. The MAC assesses three core domains of functional movement (head control, upper extremities and hands, pelvis and lower extremities), and generates a core total score. Four explanatory domains serve to alert examiners to factors that may impact atypical development (general observations, special senses, primitive reflexes/reactions, muscle tone). Construct validity of functional motor development was examined using the relationship between incremental increases in scores and increases in participants' ages. Subsamples were used to establish inter-rater reliability, test-retest reliability, stability and sensitivity to change. RESULTS: Construct validity was established and inter-rater reliability ICCs for the core items and core total ranged from 0.83 to 0.99. Percent agreement for the explanatory items ranged from 0.72 to 0.96. Stability within age grouping was consistent from baseline to 6 months post-baseline, and sensitivity to change from baseline to 6 months was significant for all core items and the total score. CONCLUSION: The MAC has proven to be a well-constructed assessment of infant and toddler functional motor development. It is a family-centred and efficient tool that can be used to assess and follow-up of infants and toddlers from 2 months to 2 years.

Prenatal exposure to alcohol and marijuana: effects on motor development of preschool children.

Gross motor development of preschool children prenatally exposed to alcohol and marijuana was assessed as part of a longitudinal study. Most mothers in the study were light to moderate users and discontinued or decreased use of alcohol and marijuana after the first trimester of pregnancy. The women were of lower socioeconomic status, half of the sample was African-American, and most were single. Gross motor development was evaluated with balance and ball-handling items at 3 years. Balance items included walking on a line, walking on a balance beam, standing on one foot, standing on tiptoes, and stair climbing and descent. Ball-handling items included catching, throwing, and kicking a ball. Refusal to perform items was also recorded. Prenatal alcohol and marijuana exposure did not negatively affect gross motor development. The composite score on the Stanford-Binet Intelligence Scale, age at assessment, gender, and examiner were significant predictors of gross motor performance and of refusal to participate in the balance items. The ponderal index, number of siblings, current income, examiner, current maternal use of tranquilizers, and first trimester exposure to amphetamines were also significant predictors of balance skills. Gender and number of hospitalizations predicted refusal to participate in balance items, whereas hearing and vision problems predicted refusal on ball-handling items. The components of timing, speed, and fine motor control have not been addressed in this study, and therefore it is premature to conclude that there is no impact of prenatal substance use on motor development.

Effect of prostaglandin F(2)alpha at insemination on sperm cell numbers and pregnancy rate in beef cattle.

Fourteen cycling, nonlactating, multiparous beef cows were artificially inseminated (AI) 10 to 12 h after the onset of natural estrus. One unit of frozen-thawed semen containing 100 x 10(6) total sperm cells was deposited into the body of the uterus. Immediately after AI, alternating cows were injected i.m. with either 25 mg (5 ml) of prostaglandin F(2)alpha (PGF) or 5 ml of 0.9% saline-benzyl alcohol control solution. Cows were slaughtered 16 +/- 1 h post AI, oviducts were retrieved, segmented into thirds (upper, middle and lower) and flushed with 1 ml of 0.2% gluteraldehyde in phosphate buffered saline. The number of sperm cells was counted using a phase contrast microscope. There were no right or left side effects (P=0.61) on the number of sperm cells recovered per oviduct within cow (389 vs 553; average SEM = 219). PGF had no effect (P=0.77) on the number of sperm cells recovered per oviduct (642 vs 300; average SEM = 231 for PGF and control females, respectively). More sperm cells were recovered from the lower third segment (P<0.05) compared with the middle and upper segments. Ovulation tended to affect (P=0.10) the number of sperm cells recovered per oviduct (742 vs 200; average SEM = 231). Additionally, 114 beef females (68 Angus x Hereford heifers and 46 Chianina crossbred postpartum suckled cows) were treated as described above following AI at natural estrus with 20 x 10(6) motile sperm cells. Pregnancy rates did not differ significantly in heifers (70.6 vs 58.8%) or in Chianina cows (34.8 vs 52.2%) for control and PGF-treated females, respectively. Overall, pregnancy rates were identical between control and PGF-treated females at 56.1%. In this study, PGF treatment immediately following AI in beef cattle had no effect on the number of sperm cells in the oviducts or on the pregnancy rate.

Predictive validity of the "Movement Assessment of Infants".

Early identification of neuromotor deficits, cerebral palsy or other neurological handicaps, is a focus of concern for neurologists, pediatricians, and developmental therapists. Among infants at risk for developing these handicaps are those with low birthweight, idiopathic respiratory distress syndrome, and early central nervous system insults. The Movement Assessment of infants (MAI), a neuromotor assessment tool, was developed for the purpose of evaluating high-risk infants participating in the University of Washington's Neonatal Intensive Care Unit Followup Clinic. The predictive validity of the MAI was evaluated for 246 infants for whom assessments had been completed at four months and for whom at least one set of followup data was available at either one or two years of age. Correlations between the MAI total risk score and all five of the outcome measures at one and two years were highly significant. The clinical relevance of this study in the use of the MAI as an evaluation tool for identifying infants with neuromotor dysfunction is discussed.

Spastic diplegia in premature infants. Etiologic and diagnostic considerations.

To investigate the etiology of spastic diplegia (SD) of prematurity, we compared the prenatal, perinatal, and neonatal course of 18 preterm infants with SD to that of a control group of preterm infants without SD. No significant differences between the group with SD and the control group were found in most of the perinatal and neonatal factors analyzed. Significant differences were found in birth weight, birth head circumference, and the one-minute Apgar score. Controlling for gestational age, infants with SD weighed less at birth, had smaller heads, and were more often briefly neurologically depressed. Intracranial hemorrhage and neonatal seizures occurred significantly more often in infants with SD. Fifteen infants with SD were believed to be neurologically normal at the time of nursery discharge. These findings suggest the importance of prenatal factors in optimally treated preterm infants in whom SD develops.