Behaviour of 4- to 5-year-old nondisabled ELBW children: Outcomes following group-based physiotherapy intervention.

BACKGROUND: Extreme prematurity or extremely low birth weight (ELBW) can adversely affect behaviour. Nondisabled ELBW children are at risk of behavioural problems, which may become a particular concern after commencement of formal education. This study explored the frequency of behavioural and emotional problems amongst nondisabled ELBW children at 4 to 5 years of age and whether intervention had a positive influence on behaviour. The relationship between behaviour, gender, and other areas of performance at 5 years was explored. METHODS: Fifty 4-year-old children (born <28 weeks gestation or birth weight <1,000 g) with minimal/mild motor impairment were randomly allocated to intervention (n = 24) or standard care (n = 26). Intervention was 6 group-based physiotherapy weekly sessions and home programme. Standard care was best practice advice. The Child Behavior Checklist (CBCL) for preschool children was completed at baseline and at 1-year post-baseline. Other measures at follow-up included Movement Assessment Battery for Children Second Edition, Beery Visual-Motor Integration Test 5th Edition, and Peabody Picture Vocabulary Test 4th Edition. RESULTS: The whole cohort improved on CBCL total problems score between baseline (mean 50.0, SD 11.1) and 1-year follow-up (mean 45.2, SD 10.3), p = .004. There were no significant differences between groups over time on CBCL internalizing, externalizing, or total problems scores. The intervention group showed a mean difference in total problems score of -3.8 (CI [1.5, 9.1]) between times, with standard care group values being -4.4 (CI [1.6, 7.1]). Males had higher total problems scores than females (p = .026), although still performed within the "normal" range. CBCL scores did not correlate with other scores. CONCLUSIONS: The behaviour of nondisabled ELBW children was within the "normal" range at 4 to 5 years, and both intervention and standard care may have contributed to improved behavioural outcomes. Behaviour was not related to performance in other developmental domains.

Visual-motor integration performance in children with severe specific language impairment.

BACKGROUND: This study investigated (1) the visual-motor integration (VMI) performance of children with severe specific language impairment (SLI), and any effect of age, gender, socio-economic status and concomitant speech impairment; and (2) the relationship between language and VMI performance. It is hypothesized that children with severe SLI would present with VMI problems irrespective of gender and socio-economic status; however, VMI deficits will be more pronounced in younger children and those with concomitant speech impairment. Furthermore, it is hypothesized that there will be a relationship between VMI and language performance, particularly in receptive scores. METHODS: Children enrolled between 2000 and 2008 in a school dedicated to children with severe speech-language impairments were included, if they met the criteria for severe SLI with or without concomitant speech impairment which was verified by a government organization. Results from all initial standardized language and VMI assessments found during a retrospective review of chart files were included. RESULTS: The final study group included 100 children (males = 76), from 4 to 14 years of age with mean language scores at least 2SD below the mean. For VMI performance, 52% of the children scored below -1SD, with 25% of the total group scoring more than 1.5SD below the mean. Age, gender and the addition of a speech impairment did not impact on VMI performance; however, children living in disadvantaged suburbs scored significantly better than children residing in advantaged suburbs. Receptive language scores of the Clinical Evaluation of Language Fundamentals was the only score associated with and able to predict VMI performance. CONCLUSIONS: A small subgroup of children with severe SLI will also have poor VMI skills. The best predictor of poor VMI is receptive language scores on the Clinical Evaluation of Language Fundamentals. Children with poor receptive language performance may benefit from VMI assessment and multidisciplinary management.

Quality of life in young people with cystic fibrosis: effects of hospitalization, age and gender, and differences in parent/child perceptions.

BACKGROUND: The Cystic Fibrosis Questionnaire-Revised version (CFQ-R) was used to evaluate age/gender effects on quality of life (QOL) in Australian young people with cystic fibrosis (CF) who were inpatients/outpatients aged 6-18 years. Parent/child agreement was also examined. METHOD: The CFQ-R was completed by 18 outpatients, and 15 inpatients at admission for an acute pulmonary exacerbation to a tertiary hospital, Brisbane, Australia, as well as by parents of those aged 6-13 years. RESULTS: Inpatients scored significantly lower than outpatients for the CFQ-R domains 'emotional state', 'social', 'body image' and 'respiratory symptoms'. Young people aged 6-13 years scored significantly better than those aged 14-18 years for 'emotional state', 'body image' and 'treatment burden'. Women perceived less 'treatment burden' than did men. Young people aged 6-13 years perceived less 'treatment burden' than did their parents. A significant interaction occurred between child/parent report and gender for 'emotional state' and 'eating disturbances'. CONCLUSION: The CFQ-R found differences between inpatients and outpatients and between younger and older paediatric patients with CF, and between parent and child perceptions of QOL.

Development of lumbrical control in children aged four to six years.

This study was undertaken to provide data on the range and quality of movement performances in normal four, five and six year olds, when asked to demonstrate a simple lumbrical pattern of MCP flexion and IP extension in combination with wrist extension. The study also evaluated the ability to isolate individual movements of the thumb, third and fifth digits against the stable background posture. Lumbrical control appears poorly developed at four years, but improves from four to six years of age. The ability to isolate individual finger movements from the basic resting position improved across the three age levels. The results of this study revealed little difference between the performances of boys and girls, or between performances with either hand.

Repeatability of three fine motor tests.

This study evaluated the repeatability of three fine motor tasks in normal children aged nine years. Using set procedures and well defined scoring categories, finger drumming, sequential finger/thumb opposition and finger tapping were shown to be repeatable quantitatively and qualitatively. Drumming and finger tapping (but not opposition) showed differences between hands, and movement in the easy direction was better than that in the difficult direction for drumming and opposition. Children demonstrate a preferred or easy direction of movement for drumming and for opposition, which must be considered when assessing hand function. This study has provided repeatability information for three tests, as well as baseline data against which children with motor impairment can be evaluated.

Minimal cerebral dysfunction in adults.

Awareness of minimal cerebral dysfunction (MCD) in children has increased in recent years and suitable management programmes have been developed. However, there has been less recognition that appropriate assessment and treatment might be provided for adults showing characteristic signs of MCD. A preliminary study was therefore carried out to ascertain the nature of the neurological deficits in adults presenting for assessment and to determine their responsiveness to treatment. A comparison of information relating to background features and neurological assessment with data collected from a reported study of MCD children revealed marked similarities between the two groups and demonstrated that major deficits in MCD children can continue to adulthood, creating functional difficulties in such important areas as reading, writing, spelling, memory and co-ordination.

A review of the histories of children with minimal cerebral dysfunction.

Although many factors have been thought to contribute to the development of minimal cerebral dysfunction (MCD), the aetiology of the condition has not been clearly specified. The existence of MCD can be associated with behavioural, emotional or educational problems, so that control of contributing factors can have important implications for the child. As part of a broad study of MCD carried out in the Department of Physiotherapy, University of Queensland, historical data were collected for 1,020 children who attended the MCD clinic. A comparison of the incidence of each of these factors with that in the normal population, highlighted a number of features which could bear further study.

Patterns of improvement in neurological functioning of children with minimal cerebral dysfunction with physiotherapy intervention.

Sixty-four children with minimal cerebral dysfunction (MCD) were studied to evaluate the effectiveness of using a developmental physiotherapy approach to treatment. Assessments of the children's performance in major areas of neurological development were made initially and after six months. In addition, a twelve months assessment allowed a determination of whether early progress was maintained after cessation of treatment. Analyses of results revealed that physiotherapy treatment does ameliorate the neuro-developmental problems seen in children with MCD, and that beneficial effects are well established after six months. On cessation of treatment, the children maintained the better level of functioning for a further six months in comparison to the control group. Resolution of neurological problems after a relatively brief period of physiotherapy justifies this form of intervention for children with MCD.

Developmental physiotherapy for children with both minimal cerebral dysfunction and learning difficulties.

Early research studies have suggested that learning gains accompany improvement in neurological factors after developmental physiotherapy treatment, and some physiotherapists consider that an adequate sensory motor system is of primary importance in the utilisation of full learning abilities. To determine the existence of any link between these two, a study was undertaken to evaluate educational progress of children with both MCD and learning difficulties: the experimental group received continuous physiotherapy management for six months and the control group received no physiotherapy, if possible, while all continued their remedial education programme. Analysis of school performance data revealed that the educational progress in most areas assessed by teachers was significantly greater for the children in the experimental group than for the control group. This paper describes the study and compares the scholastic achievement of children, with and without physiotherapy intervention.

A study of the effectiveness of physiotherapy in the management of young children with minimal cerebral dysfunction.

Minimal cerebral dysfunction (MCD) is one of many terms used to describe the syndrome exhibited by children who demonstrate mild abnormalities on clinical neurological assessment. The neurological signs of minimal cerebral dysfunction are manifested in the nature of the reflex and automatic sensory responses as well as in the motor responses to specific stimulations. Those reactions which persist beyond the normal age for their integration, together with other mild signs of neurological dysfunction are also symptomatic of minimal cerebral dysfunction.

Identification and developmental assessment of children with neurological impairment.

During foetal life, at birth and in the first few post-natal months, the brain is particularly vulnerable to damage. It is at this time that there is rapid development of the central nervous system, a merging of early primitive responses with more complex and later, highly integrated and adaptive responses, and the development of purposeful physical activities.

Developmental perceptual-motor disorders.

To understand or even begin to conceive the problems of the perceptually-motor handicapped is an enormous task. We have developed our personalities and abilities in a stable and meaningful environment and our security lies in our ability to manipulate and give meaning to this environment. Imagine the difficulties that are faced by a child with perceptual-motor problems. By this, we mean that he has problems with: (1) inaccurate or distorted input in the fields of vision, audition, proprioception, kineasthesia and tactility, (2) inaccurate integration of this input, (3) inaccurate motor output or inadequate responses.