Studies have found that there is a tight interdependence between mental, neuromusculoskeletal, and movement-related functions in terms of global development. Pediatricians, parents, child-care, and teachers must be aware that the growing brain and body are deceptively capable of hiding cognitive and motor functions delays and deficits. For this reason, early diagnosis and intervention is essential for children born premature or with low birth weight. Early preterm infants are more likely to have delays in fine motor and gross motor functions, working memory, and sensory integration. This cohort was also found to display deficits in visuomotor, visuospatial, cognitive, and other skills related to education. There is a wealth of studies on very preterm children. However, moderate to late preterm infants should be monitored for early diagnosis of neuropsychological disorders related to visual-motor, visual-perception, and language development.
2. Larger Cerebellar Volumes were Associated with Higher Motor
Composite Scores on the Bayler-III in 2-year old Toddlers Born
Moderate (32-33) to Late Preterm (34-36)
2
The Cerebellum is Responsible for Motor Functions
~Rapid Third Trimester Cerebellar Growth is Impeded by Preterm Birth~
(Cheong, Thompson, Spittle, Potter, Walsh, Burnett, Lee, Chen, et al., 2016; Limperopoulos et al., 2005 in Jiang, et al., 2012)
King, 2012
Larger Cerebellar Volumes are Associated with
Higher Motor Composite Scores on the Bayler-III in
2-year old Moderate (32-33) to Late Preterm (34-36) Toddlers
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3. Global Development in Relation to
Mental – Neuromuscular – Movement Abilities
3
(Aylward, 2002 in Lubsen, et al., 2011; Nadeau et al., 2001 in 2011; Rose et al., 2008 in 2011; (Diamond, 2000 in Park,
et al., 2014; Koziol, Budding, & Chidekel, 2012 in 2014; Wassenberg et al., 2005 in 2014)
There is a tight Interdependence
between Mental, Neuromusculoskeletal
and Movement-Related functions in
terms of Global Development.
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4. The Posterior Part of the Thalamus is Connected to the
Posterior Parts of the Cerebral Cortex
The Thalamus Nuclei is connected to the:
Motor cortex
Prefrontal cortex
Increasing prematurity is related to volume reduction, neuronal loss, gliosis, and axonal
abnormality in the thalamus (Ball, et al., 2012; Volpe, 2009)
4
Parietal Lobe
Occipital Lobe
Temporal Lobe
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5. Early Preterm (EPT) Infants Experience Multiple Delays
Compared with Full-Term Infants, EPTs are more likely to have
Delays in
Fine and gross motor functioning
Sensory integration
Cognitive functioning
Communication
Behavioral and socio-emotional problems
5
(Kerstjens, et al., 2011 citations: Stephens & Vohr, 2009; Saigal & Doyle, 2008; Taylor, Klein, & Hack, 2000;
Marlow, 2004; Hokken-Koelega, 2017)
(2017)
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6. In order for the brain to cope with the demands of formal education, it needs to be
exposed to and learn to deal with a rich variety of sensory and motor experiences,
both at home and in early childhood education facilities.
6(Karabulut, 2013)
Formal Educational Experiences Enhance Sensory Motor Perceptions
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7. Adverse Effects of Medical Treatment that take a
Long Time to become Apparent are harder to
uncover
7
The Growing Brain and Body are Deceptively Capable of Keeping Adverse Preterm
Effects Hidden Until Cognitive and Motor Functions can be Meaningfully Evaluated
(Jain, 2008)
Long-term follow-up for moderate and late preterms is need.
Adverse effects of some neonatal medical treatments
and morbidities take a long time to become apparent,
making them harder to uncover.
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8. Preterm Children Present with a Unique Pattern of Cognitive
Deficits Including:
8
Visuomotor skills
Visuospatial skills
Executive function skills
Non-verbal learning disabilities independent of IQ
Early language development
(Sansavini, et al., 2007; Bayless & Stevenson, 2007; Stolt, 2007; Baron, et al., 2009; Waber & McCormick, 1995; Anderson & Doyle,
2004; Aylward, 2002; Bayless & Stevenson, 2007; Fazzi, et al., 2009; Feng, et al., 2011; Kirkeguard, et al., 2006; Short, et al., 2003; Wolke
& Meyer, 1999)
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9. 9
A Sequential Chain of Effects that starts with
Preterm Birth may lead to specific deficiencies in
Neuro-Motor and Behavioral functions, in addition
to Cognitive, Language, Reading, and Skills.
(Aylward, 2002 in Lubsen, et al., 2011; Nadeau et al., 2001 in 2011; Rose et al., 2008 in 2011; (Diamond, 2000 in Park,
et al., 2014; Koziol, Budding, & Chidekel, 2012 in 2014; Wassenberg et al., 2005 in 2014)
Preterm Births May be Linked to Specific Deficiencies
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10. Preterm Births are Associated with
Learning Explicit Motor Skills
Children born preterm have a higher risk for
developing motor, cognitive, and working memory
problems. Working memory is important for explicit
learning of motor skills.
(Jongbloed-Perwboom, Janssen, Steenburgen, & Steenburgen, 2012; Sinha, 2013)
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10
11. Motor Development Similarities between
Very Preterm and Late Preterm Births
(Baron, et al., 2011 check references 10 11 & 12; de Kieviet, Piek, Aarnoudse-Moens, Oosterlaan, 2009 in Lee, et al., 2011)
11
Late-Preterm Infants may
also Experience Subtle to
Extreme Motor Impairment
Motor Development problems in
Very Preterm and Very Low-Birth
Weight Children from Birth to
Adolescence are Common
What was
already known
What Researchers
are finding
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12. 12
(Caravale, et al., 2012; van Otterloo, van der Leij, Henrichs, 2009 in 2012; Kirk & Gillon,
2007 in 2012; Guarini, Sansavini, Fabbri, Savini, Alessandroni, Faldella, et al., 2010 in 2012)
Improve Outcome
by Allowing Timely
Rehabilitation
Therapy
to
Prevent more
Complex
Learning
Disabilities
Such as
Developmental
Dyslexia
Dyscalculia
At School Age
Moderate to Late Preterm Infants should be Monitored for Early Diagnosis of
Neuropsychological Disorders related to
Visual-Motor, Visual-Perceptual, and Language Development
(Math difficulties)
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13. End of
Effects Preterm Birth on Motor
Skills – Part I
13ozella.brundidge@gmail.com 6/22/2017
(Rebis, 2017)
Editor's Notes
vThe cerebellum receives information from the sensory systems, the spinal cord, and other parts of the brain and then regulates motor movements. The cerebellumcoordinates voluntary movements such as posture, balance, coordination, and speech, resulting in smooth and balanced muscular activity (https://www.google.com/webhp?sourceid=chrome-instant&rlz=1C1CHZL_enUS698US698&ion=1&espv=2&ie=UTF-8#q=function+of+cerebellum&*)
Rose and colleagues reported a cascade of effects resulting from prematurity, in which infant processing speed influenced memory and representational competence, which in turn influenced mental development at age 2 to 3 years (Rose et al., 2009; Rose et al., 2005, 2008). Slower processing speed seems to persist into adulthood (Strang-Karlsson et al., 2010). These studies did not specifically control for
the effect of IQ on speed of processing
Cognitive neuroscience online textbook (citation)
Gareth Ball1, James P. Boardman1,2, Daniel Rueckert3, Paul Aljabar3, Tomoki Arichi1,4, Nazakat Merchant1,4, Ioannis S. Gousias1,
A. David Edwards1,4 and Serena J. Counsell
Their (late-preterms) reputation for being prone to transient clinical problems may have led to a less rigorous approach to their perinatal and postnatal management and to the absence of prospective data sets that track outcomes. Recent observations of significantly higher neonatal morbidity
and mortality have raised concerns about these issues, and studies that the late preterm brain can be at risk for periventricular leukomalacia have further fueled this anxiety.3-6
CITATIONS IN JAIN 2008
3. McIntire DD, Leveno KJ. Neonatal mortality and morbidity rates in late preterm births compared with births at term. Obstet Gynecol 2008;111:35-41.
4. Tomashek KM, Shapiro-Mendoza CK, Davidoff MJ, Petrini JR. Differences in mortality between late-preterm and term singleton infants in the United States, 1995-2002. J Pediatr 2007;151:450-6.
5. Jain L, Dudell GG. Respiratory transition in infants delivered by cesarean section. Semin Perinatol 2006;30:296-304.
6. Kinney HC. The near-term (late preterm) human brain and risk for periventricular leukomalacia: a review. Semin Perinatol 2006;30:81-8.
MORBIDITIES
Problems reported in late preterm infants include delayed lung fluid clearance (transient tachypnea of the newborn infant), respiratory distress syndrome, pulmonary hypertension, apnea, temperature instability, hypoglycemia, jaundice, and poor feeding.7-11 Little, however, is known about the long-term
impact of these neonatal morbidities.
CITATIONS IN JAIN 2008
7. Jain L, Eaton DC. Physiology of fetal lung fluid clearance and the effect of labor. Semin Perinatol 2006;30:34-43.
8. Raju TN, Higgins RD, Stark AR, Leveno KJ. Optimizing care and outcome for late-preterm (near-term) infants: a summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics 2006;118:1207-14.
9. Bhutani VK, Johnson L. Kernicterus in late preterm infants cared for as term healthy infants. Semin Perinatol 2006;30:89-97.
10. Dudell GG, Jain L. Hypoxic respiratory failure in the late preterm infant. Clin Perinatol 2006;33:803-30.
11. Wang ML, Dorer DJ, Fleming MP, Catlin EA. Clinical outcomes of near-term infants. Pediatrics 2004;114:372-6.
Rose and colleagues reported a cascade of effects resulting from prematurity, in which infant processing speed influenced memory and representational competence, which in turn influenced mental development at age 2 to 3 years (Rose et al., 2009; Rose et al., 2005, 2008). Slower processing speed seems to persist into adulthood (Strang-Karlsson et al., 2010). These studies did not specifically control for
the effect of IQ on speed of processing
Sinha, B. (2013). Development assessment. Retrieved from https://www.slideshare.net/binishasinha/developmental-assessment