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Clinical evaluation of motor development
Published in Ajay Sharma, Helen Cockerill, From Birth to Five Years, 2021
Primitive reflexes are patterns of spontaneous involuntary movements seen soon after birth (Table 2.1). Their disappearance, by 4–6 months of age, is a prerequisite for the appearance of coordinated voluntary movements. Their persistence beyond 6 months or re-emergence indicates a pathology of the central nervous system. Protective reflexes develop from 4–5 months onwards and can be absent or asymmetrical in motor disorders (Table 2.2).
The newborn baby
Published in Ajay Sharma, Helen Cockerill, Lucy Sanctuary, Mary Sheridan's From Birth to Five Years, 2021
Ajay Sharma, Helen Cockerill, Lucy Sanctuary
Primitive reflexes are intricate automatic movement patterns generated by the lower brain (brainstem). They commence as early as the 25th week of gestation and are fully present at birth in term infants. They become more difficult to elicit over the coming months as the cortical inhibition emerges, and protective postural reactions appear. Persistence and asymmetry of primitive reflexes indicate an underlying neurological impairment.
5.00: Movement
Published in Fiona Broadley, Supporting Life Skills for Young Children with Vision Impairment and Other Disabilities, 2020
Movement begins even before birth and skills are developed through reflexes. These reflexes assist with the birthing process, support survival and provide rudimentary training for developing voluntary skills and movement. These reflexes are inhibited by the brain as the skills develop. Examples of primitive reflexes include rooting and the startle reflex. There is a lovely video on YouTube demonstrating all the reflexes found in a newborn baby (see ‘Useful websites’ above).
Balance functions and primitive reflexes in dyslexic children
Published in Hearing, Balance and Communication, 2023
Nagwa Hazzaa, Amany Shalaby, Sahar Hassanein, Ahmed Khattab, Nancy Metwally, Fathy Naeem
Primitive reflexes are (brainstem and spinal cord mediated), complex, automatic movement patterns that commence as early as the 25th week of gestation. They are fully present at birth in term infants. They are the first part of the brain to develop and should only remain active for the first few months of life. They provide the basis for automatic control of posture, balance and coordination in a gravity‐based environment. They provide the postural framework for adaptive, voluntary and skilled movements [2].
Botulinum Toxin Type A in the Spasticity of Cerebral Palsy Related to Congenital Zika Syndrome: An Observational Study
Published in Developmental Neurorehabilitation, 2022
Giulia Armani-Franceschi, Cleber Luz, Pedro H. Lucena, Danilo d’Afonseca, Henrique Sales, Alessandra L. Carvalho, Isadora C. Siqueira, Karine Silva, Sandra Portuense, Larissa Monteiro, Igor D. Bandeira, Ailton Melo, Rita Lucena
One of the main challenges to our study was the definition of parameters to assess muscle tone. The children presented severe functional impairment, with significant muscle hypertonia and intense reactivity to motor assessment maneuvers. More than half demonstrated persistent primitive reflexes, which are also negatively associated with motor prognosis, as seen in other studies.41,42 In this study, in order to standardize data collection, an attempt was made to evaluate the spasticity of the biceps, adductor longus and hamstrings by analyzing muscle electrical activity through surface electromyography (EMG) in 10 children. We proposed to obtain parameters through the Hilbert–Huang transform43 according to EMG records made before, during, and after muscle stretching. However, we found that when this assessment was applied to children with CZS, there were complications for the optimal collection of EMG signals, such as interference from primitive reflexes and the already greatly increased basal tone. Goniometry was also considered as an outcome assessment parameter, but it did not prove to be accurate, with wide intra-individual variation in tone and range of motion in assessments repeated at five-minute intervals, even when performed under the same conditions (temperature and positioning of the child). We therefore opted to use MAS, a widely used resource in similar studies. However, it should be noted that its reliability and reproducibility have been called into question and there has been evidence of clinimetric inconsistencies, as also seen with the Tardieu scale.44,45 The PGI-I provided additional elements for a subjective analysis of the outcome, inferring that the toxin has an impact on functionality, which appears to be more clinically relevant than the objective muscle tone measurements. In other words, a reduction in tone in a specific muscle group following botulinum toxin did not, in isolation, determine the efficacy of the treatment, except when this was accompanied by a clinically relevant positive result, with a corresponding impact on the quality of life of the child and their family. The perception of improvement might be the best clinical indicator of response to the toxin in this population, given the severe motor impairment and low prospect of improvement.
A Newborn with Congenital Hyperinsulinism
Published in Fetal and Pediatric Pathology, 2019
Yiting Du, Rong Ju, Yufeng Xi, Peng Gou
This male infant was brought to our hospital with hypoglycemia that developed 5 minutes after birth. He was the mother's first child, delivered at 42 weeks, his weight was 4420 g. The child’s Apgar scale scores at 1, 5, and 10 minutes after birth were 9, 10, and 10, respectively. His mother had gestational diabetes mellitus. Physical examination revealed the following: temperature of 36.6 °C, pulse of 142 beats/minute, slightly elevated respiration rate of 49 breaths/min, head circumference of 37 cm, mature full-term appearance, good responses, strong cry, anterior fontanel measuring 2.0 cm × 2.0 cm and a flat, ruddy appearance to his face. There were no signs of cardiac, lung or abdominal abnormalities on physical examination. The muscle tension of his extremities was normal. The four main primitive reflexes including moro reflex, grasp reflex, sucking reflex, and rooting reflex, could be drawn out completely. His peripheral blood glucose level at 30 minutes after birth was 1.7 mmol/l; intravenous blood glucose in normal healthy newborns should not be lower than 2.2 mmol/l regardless of gestational age [4]. After admission, he had a serum blood glucose level of 0.39 mmol/l, normal electrolyte levels, a fasting insulin level of 59.17 mU/l (fasting insulin < 10mU/l) [5]. His progesterone, testosterone levels, cortisol levels, thyroid function, blood ammonia, complete blood count, and urinary metabolism were normal. There were no abnormal changes observed on bilateral adrenal ultrasound, thyroid ultrasound, pancreatic ultrasound or pancreatic plain and enhanced computed tomography (CT) scans. He received continuous intravenous infusion of glucose at a rate of 13 mg/kg/min after admission. His intake of formula with 10% sugar was gradually increased to complete feeding, and he received hydrocortisone injections. Poor blood sugar control was noted. Diazoxide was administered up to 15 mg/kg/d for 7 days, but hypoglycemia was frequent, and his blood sugar levels fluctuated between 1.1 and 3.5 mmol/l. The treatment was changed to octreotide acetate for 6 days at a dose of 7.2 μg/kg.d. The intravenous administration of cellulose was gradually reduced, and his blood sugar level fluctuated between 3.6 and 5.8 mmol/l. The child was discharged from the hospital to his parents, fed exclusively with formula containing 10% sugar, and administered subcutaneous injections of octreotide acetate. The dose of octreotide acetate was adjusted to 20 μg/kg.d after outpatient follow-up. His blood sugar level, liver function and kidney function were normal. [18F]6-Fluoro-3, 4-dihydroxy- L-Phenylalanine Positron Emission Computed Tomography (18F-DOPA-PECT) of the pancreas was not obtained. In summary, the child was diagnosed with ATP-sensitive potassium channel congenital hyperinsulinemia (KATP-HI) according to the CHI diagnostic criteria [6].