GM - Lectura recomendada - Presentación en Portugal - El dolor en bebés - Tummytime- El recién nacido asimétrico -Como hacer un nido - Teoría del dessarollo motriz - Plasticidad del celebro - Dolor
The assessment of the quality of General Movements
- Bos AF, Van Loon AJ, Hadders-Algra M, Martijn A, Okken A, Prechtl HFR.
Spontaneous motility in preterm, small for gestational infants. II Qualitative aspects. Early Hum Dev 1997; 50:131-47.
- Bos AF, Martijn A, Van Asperen RM, Hadders-Algra M, Okken A, Prechtl HFR. Qualitative assessment of general movements in high risk preterm infants with chronic lung disease requiring dexamethoasone therapy. J.paedatr 1998; 132:300-6.
- Bos AF, Martijn A, Okken A, Prechtl HFR. Quality of general movements in preterm infants with transient periventricular echodensities. Acta Paediatr 1998;87:328-35.
- Bouwstra H, Dijck-Brouwer DAJ,Wildeman JAL, Tjoonk HM, Van der Heide JC, Boersma ER, Muskiet FAJ, Hadders-Algra. Long-chain polysaturated fatty acids have a positive effect on the quality of general movements of healthy term infants. Am J. Clin Nutr 2003;78:313-8.
- Bouwstra H, Groen SE, Hadders-Algra M. Quality of general movements and cognitive and behavioural outcome at 9 to 12 years in children without cerebral palsy. Submitted for publication.
- Cioni G, Ferrari F, Einspieler C, Paolicelli P, Barbani MT Precht HFR. Comparison between observation of spontaneous movements and neurological examination in preterm infants. J. paediatr 1997;130:704-11
- Cioni G, Prechtl HFR, Ferrari F, Paola B, Einspieler C, Roversi MF. Which better predicts later outcome in full term infants: quality of general movements or neurological examination? Early Hum Dev 1997;50:71-85.
- De Graaf-Peters VB, De Groot-Hornstra AH, Dirks T, Hadders-Algra M. Specific postural support promotes variation in motor behaviour of infants with minor neurological dysfunction. Dev Med Child Neurol 2006, 48: 966-972
- Einspieler C, Prechtl HFR, Bos AF, Ferrari G, Cioni G. Prechtl´s method on the qualitative assessment of general movements in preterm, term and young infants. Clin Dev Med No 167. London: Mac Keith Press, 2004.
- Ferrari F, Cioni G, prechtl HFR. Qualitative changes of general movements in preterm infants with brain lesions. Early Hum Dev 1990;23:193-231.
- Ferrari F, Cioni G, Einspieler C, Roversi MF, Bos AF, Paolicelli PB, Ranzi A, Prechtl HFR. Cramped synchronized general movements in preterm infants as an early marker of cerebral palsy. Arch Pediatr Adolesc Med 2002;156:460-7.
- Groen SE, de Blécourt ACE, Postema K, Hadders-Algra M. Quality of general movements predicts neuromotor development at the age of 9-12 years. Dev Med Child Neurol 2005;47:731-8.
- Hadder-Algra M. General movements in early infancy: what do they tell us about the nervous system? Early hum Dev 1993;34:29-37.
- Hadders-Algra M. The neuronal Group Selection Theory; an attractive framework to explain variation in normal motor development. Dev Med Child Neurol 2000a;42:566-72.
- Hadders-Algra M. The Neuronal Group Selection Theory: promising principles for understanding and treating developmental motor disorders. Dev Med Child Neurol 2000b;42:707-15.
- Hadders-Algra M. Two distinct forms of minor neurological dysfunction; perspectives emerging from a review of data of the Groningen Perinatal Project. Dev Med Child Neurol 2002;44:561-71.
- Hadder-Algra M. Developmental Coordination disorder: Is clumsy motor behaviour caused by a lesion of the brain at early age? Neural Plast 2003;10:39-50.
- Hadders-Algra M. General movements: a window for early identification of children at high risk of developmental disorders. J. Pediatr 2004;145:S12-18.
- Hadders-Algra M, Groothuis AMC. Quality of general movements in infancy is related to the development of neurological dysfunction, attention deficit hyperactivity disorder and aggressive behaviour. Dev Med Child Neurol 1999;41:391-91.
- Hadders-Algra M, Prechtl HFR. Developmental course of general movements in early infancy. I: Descriptive analysis of change in form. Early Hum Dev 1992;28:201-14.
- Hadders-Algra M, Klip-Van den Nieuwendijk AWJ, Martijn A, Van Eykern LA. Assessment of general movements: towards a better understanding of a sensitive method to evaluate brain function in young infants. Dev Med Child Neurol 1997;39:88-98.
- Hadders-Algra M, Mavinkurve-Groothuis AMC, Groen SE, Stremmelaar EF, Martijn A, Butcher PR. Quality of general movements and the development of minor neurological dysfunction at toddler and school age. Clin Rehabil 2004;18:287-99.
- Hadder-Algra M, Nakae Y, Van Eykern LA, Klip-Van den Nieuwendijk AWJ, Prechtl HFR. The effect of behavioural state on general movements in healthy fullterm newborns. A. Polymyographic study. Early Hum Dev 1993;35:63-79
- Hadder-Algra M, Van Eykern LA, Klip-Van den Nieuwendijk AWJ, Prechtl HFR. Developmental course of general movements in early infancy. II. EMG correlates. Early Hum Dev 1992;28:231-52.
- Hopkins B, Prechtl HFR. A qualitative approach to the development of movements during early infancy. In: Continuity of neural functions form prenatal to postnatal life. Prechtl HFR ed. Clin.Dev.Med. No 94. Oxford: Blackwell Scientific Publications; 1984:179-97.
- Mazzone L, Mugno D, Mazzone D. The general Movements in children with Down syndrome. Early Hum Dev 2004;79:119-30.
- Prechtl HFR. The behavioural state of the infant- a review. Brain Res 1974;76:185-212.
- Prechtl HFR. Qualitative changes of Spontaneous movements in fetus and preterm infant are a marker of neurological dysfunction. Early Hum Dev 1990;23:151-8.
- Prechtl HFR. General movement assessment as a method of developmental neurology: new paradigms and their consequences. Dev med Child Neurol 2001;43:863-42.
- Prechtl HFR, Nolte R. Motor behaviour of preterm infants. In: Continuity of neural functions from prenatal to postnatal life. Prechtl HFR ed. Clin Dev med No 94. Oxford: Blackwell Scientific Publications; 1984:79-92.
- Prechtl HFR, Eindspieler C, Cioni G, Bos A, Ferrari F, Sontheimer D. An early marker of developing neurological handicap after perinatal brain lesions. Lancet 1997;339:1361-3.
- Prechtl HFR, Ferrrari F, Cioni G. Preditive value of general movements in asphyxiated fullterm infants. Early hum Dev 1993;35:91-120.
- Touwen BCL. How normal is variable, or how variable is normal? Early Hum Dev 1993;34:1-12
NB More about the international course – Assessing the GM´s- can be found on:
www.developmentalneurology.com
email address: prof. dr. mrs M. Hadders-Algra is m.hadders-algra@med.rug.nl
Esther de Ru BPT,MOT,PPT Spain tel 0034686782852 email estherderu@gmail.com
8° Congresso Nacional de Pediatria
Vilamoura Portugal 1-5 octubre 2007
Oral presentation 05-10-07
Ladies and Gentlemen,
Thank you all and thanks to prof. M. Hadders- Algra for making it possible for me to introduce the GM´s to you all.
As a paediatric physiotherapist I am the “outsider” in your midst.
Because of the health situation in Holland both doctors and
paediatric physiotherapists are be trained to assess the GM´s and they can do
so in the clinic and in the home situation. Many premature children are
treated at home after their release from Hospital.
Because of the limited time I will say little so that we can actually watch the GM´s .
1.The basic principles. The GM´s were first introduced by Prechtl in 1984.
Present from 7-8 wk PMA ( he distinguished 3 developmental stages ) to 4 months post term. They are gradually replaced by goal directed movements
The foetal or preterm GM´s 28 wk- 36/38 wk PMA postmenstrual age
Extremely variable movements, including many pelvic tilts and trunk movement
The writhing GMs 36/38 – 46/52 wk
Something forceful has been added to the variable movement (writhing). In comparison to the preterm GM´s, these seem to be somewhat slower and there is less participation of trunk and pelvis.
The fidgety GM´s 46/52- 54-58 PMA (4mth) – they gradually become more goal directed. A continuous flow of small and elegant movements occurring irregularly all over the body, i.e. head, truck and limbs participate. The small movements are sometimes superimposed by large and fast movements
By watching the GMs, we assess:
Variation, complexity and fluency and fluency is the first property to disappear when a minor degree of dysfunction is present in the nervous system. Subtle dysfunctions of NS result in movements with a jerky of stiff appearance or in tremulous movements.
the normal optimal,- abundantly variable and complex and also fluent. They are relatively rare, 10-20% of 3mnth old infants show GMs of such a beautiful quality
the normal suboptimal- sufficiently variable and complex but usually not fluent. The majority of infants show normal suboptimal movements.
the mildly abnormal- are insufficiently variable and complex and not fluent. About 20-25% of 3 month old infants in the general population show mildly abnormal GM´s
the definitely abnormal -they have little or no complexity, variation and fluency. Some children show nothing but so called cramped-synchronized patterns (suddenly occurring en-bloc movements) in which trunk and flexed or extended limbs stiffly move in synchrony. They are considered pathological when frequently seen.
2. the classification of GM quality.
In her editorial ( about foetal movements and the young nervous system in the nr 48 of Developmental Medicine & Child neurology 2006.) Hilary Hart noted that the GM assessment has received cautious recognition by some largely because of its apparent subjective nature.
The Gestalt (elegance and comfort) evaluation of complexity and variation are essential and can be learnt in 2 days ( not 5 as she stated).
Use of the video is a key feature in the training and assessment and learning to recognise the important signs takes time and practice to become a second nature.
Because I have worked in the 1st echelon I feel most comfortable judging fidgety GM´s myself. Therapists and doctors working in the ICU will see the foetal and writhing GM´s a lot more.
3. methodological issues
Yes it is time consuming- because in real life too many errors can be made, assessing later is a much better option.
The child has to be in a good state ( 4 )- In supine position, and until term age, with diaper only.
From term age on- supine in underwear.
The basis principles van be learned in 2 days.
4. Significance of abnormal GMs
- sensitive tool
- the GM´s are relatively stable within the GM phase and can be unstable in between phases
- predictive quality is highest with a series of assessments from preterm to fidgety.
- Best predication – of a single assessment is fidgety age
- constant persistence of abnormal GMs imply a very high risk for developing CP or complex form of minor neurological dysfunction specific OR
- various articles have associated abnormal GM´s with coordination problems
and fine motor problems at 9-12 yrs, vulnerability to develop attention problems, hyperactivity and withdrawn behaviour 9-12 yrs
5. Recommended reading.
I have a handout of all the recommended reading, website and email address of prof. Hadders.
The best is to follow a course. Mrs Hadders-Algra is willing to present a course in Portugal if there are enough participants. ( 20-30)
As a physiotherapist I suggest a neonatologist and a paediatric physiotherapist working in a team follow the course together.
conclusion
The GM assessment is non invasive and therefore suitable to be used in the intensive care setting, neonatal nurseries and the follow-up setting. There are limitations and
it cannot replace the MRI but it can play an important part role in theintegrated neurodevelopment assessment of the foetus and young infant.
Duerme boca arriba y Juega boca abajo
Consejos para los padres
1. Dé el biberón alternativamente al lado derecho e izquierdo (igual como cuando se da el pecho)
2. Coloque el recién nacido en una posición encorvada y apoyada de modo que la cabeza no se ponga a un lado como punto extra de apoyo (haga un nido véase las fotos) Se imita la posición en el útero con mucho apoyo en flexión en todas partes.
3. Coloque la cabeza cada vez de un lado diferente cuando el bebe vaya a dormir. Si el bebe duerme con la cabeza en la posición preferente, no gire sólo la cabeza porque el bebe se despertará casi siempre, sino gire todo el cuerpo del niño por las pierna mediante un movimiento giratorio hasta que la cabeza gire también y manténgala con cuidado mientras que coloque las piernas otra vez en su posición inicial. Los bebes casi siempre seguirán durmiendo.
4.Manejar – véase la lista adjunta de correcciones para estimular la simetría.
5. Coloque los bebes con braquicefalia de costado con un apoyo en la espalda y la barriga. También hay almohadas especiales para este fin en el mercado.
6. Intente hacer dormir de costado a los bebes que realmente no puedan o no quieran dormir boca arriba. Apóyelos con toallas o una almohada especial.
7. Procure que haya tiempo en que el niño está boca abajo. Cuanto más tiempo el bebe esté colocado y juegue boca abajo mejor.
En el principio a algunos bebes esto no les gusta nada …… por lo tanto ………
Empiece colocando al niño en su propia barriga, después sobre las rodilla, inclínalo un poco para que no le cueste demasiado elevar la cabeza.
8. Lleve el bebe en una bandolera portabebe, preferiblemente de forma horizontal mientras que el bebe no tenga un firme equilibrio de la cabeza. Llevarlo en brazo por su puesto también es perfecto.
9. Evite que el bebe esté mucho tiempo en el maxi-cosi, hamaca o silla del coche durante el transporte, su hijo de esta forma obtiene poca estimulación visual. Evite que el bebe esté mucho tiempo en un columpio o andador.
10. Coloque algún espejo cerca, estimula al bebe entrando en su campo visual (muy cerca) de esta forma provoca movimientos.
11. Coloque los juguetes favoritos un poco más lejos o sujételos, de esta manera estimula al bebe a moverse en esta dirección.
12. Después de bañar al bebe, déjelo bastante tiempo boca abajo dándole un masaje
REGLA DE ORO
Duerme boca arriba y juega boca abajo
