To address the need for a standardized system to classify the gross motor function of children with cerebral palsy, the authors developed a five-level classification system analogous to the staging and grading systems used in medicine. Nominal group process and Delphi survey consensus methods were used to examine content validity and revise the classification system until consensus among 48 experts (physical therapists, occupational therapists, and developmental pediatricians with expertise in cerebral palsy) was achieved. Interrater reliability (kappa) was 0.55 for children less than 2 years of age and 0.75 for children 2 to 12 years of age. The classification system has application for clinical practice, research, teaching, and administration.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1469-8749.1997.tb07414.x

Development and reliability of a system to classify gross motor function in children with cerebral palsy

How we raise young children is one of today's most highly personalized and sharply politicized issues, in part because each of us can claim some level of "expertise." The debate has intensified as discoveries about our development-in the womb and in the first months and years-have reached the popular media. How can we use our burgeoning knowledge to assure the well-being of all young children, for their own sake as well as for the sake of our nation? Drawing from new findings, this book presents important conclusions about nature-versus-nurture, the impact of being born into a working family, the effect of politics on programs for children, the costs and benefits of intervention, and other issues. The committee issues a series of challenges to decision makers regarding the quality of child care, issues of racial and ethnic diversity, the integration of children's cognitive and emotional development, and more. Authoritative yet accessible, From Neurons to Neighborhoods presents the evidence about "brain wiring" and how kids learn to speak, think, and regulate their behavior. It examines the effect of the climate-family, child care, community-within which the child grows.

/pdf/from-neurons-to-neighborhoods-the-science-of-early-childhood-3bfl5g72ow.pdf

From Neurons to Neighborhoods: The Science of Early Childhood Development

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ContextThe cognitive and behavioral outcomes of school-aged children who were
born preterm have been reported extensively. Many of these studies have methodological
flaws that preclude an accurate estimate of the long-term outcomes of prematurity.ObjectiveTo estimate the effect of preterm birth on cognition and behavior in
school-aged children.Data SourcesMEDLINE search (1980 to November 2001) for English-language articles,
supplemented by a manual search of personal files maintained by 2 of the authors.Study SelectionWe included case-control studies reporting cognitive and/or behavioral
data of children who were born preterm and who were evaluated after their
fifth birthday if the attrition rate was less than 30%. From the 227 reviewed
studies, cognitive data from 15 studies and behavioral data from 16 studies
were selected.Data ExtractionData on population demographics, study characteristics, and cognitive
and behavioral outcomes were extracted from each study, entered in a customized
database, and reviewed twice to minimize error. Differences between the mean
cognitive scores of cases and controls were pooled. Homogeneity across studies
was formally tested using a general variance-based method and graphically
using Galbraith plots. Linear meta-analysis regression models were fitted
to explore the impact of birth weight and gestational age on cognitive outcomes.
Study-specific relative risks (RRs) were calculated for the incidence of attention-deficit/hyperactivity
disorder (ADHD) and pooled. Quality assessment of the studies was performed
based on a 10-point scale. Publication bias was examined using Begg modified
funnel plots and formally tested using the Egger weighted-linear regression
method.Data SynthesisAmong 1556 cases and 1720 controls, controls had significantly higher
cognitive scores compared with children who were born preterm (weighted mean
difference, 10.9; 95% confidence interval [CI], 9.2-12.5). The mean cognitive
scores of preterm-born cases and term-born controls were directly proportional
to their birth weight (R2 = 0.51; P<.001) and gestational age (R2 = 0.49; P<.001). Age at evaluation had
no significant correlation with mean difference in cognitive scores (R2 = 0.12; P = .20).
Preterm-born children showed increases in externalizing and internalizing
behaviors in 81% of studies and had more than twice the RR for developing
ADHD (pooled RR, 2.64; 95% CI, 1.85-3.78). No differences were noted in cognition
and behaviors based on the quality of the study.ConclusionsChildren who were born preterm are at risk for reduced cognitive test
scores and their immaturity at birth is directly proportional to the mean
cognitive scores at school age. Preterm-born children also show an increased
incidence of ADHD and other behaviors.

https://jamanetwork.com/journals/jama/articlepdf/195181/JMA10039.pdf

Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis.

New Ballard Score, expanded to include extremely premature infants.

This investigation examined the extent to which a structured curriculum in developmental pedi­ atrics could be applied effectively to a wide range of pediatric residency training programs Residents drawn principally from sites not involved in the original development of a curriculum in developmental pediatrics were assigned randomly to prerotation control or postrotation experimental groups Based on an objective case management test, residents who had participated in the rotation defined by the curriculum scored significantly higher than those who had not Differences between experimental and control groups were similar for both the first and second evaluation years and for residents drawn from the original and new sites (total n = 161 ) Sub­ jective evaluations by residents and faculty preceptors confirmed the utility of curriculum J Dev Behav Pediatr 8:260-265, 1987 Index terms: resident training, developmental pediatrics, curriculum evaluation

https://depts.washington.edu/chdd/guralnick/pdfs/Guralnick_Bennett_etal_Training_Residents_DevPed-DVP-1987.pdf

Training residents in developmental pediatrics: results from a national replication.

Low Birth Weight Infants: Accomplishments, Risks, and Interventions

Early delay in motor development.

CASE VIGNETTE Scott was diagnosed with severe cerebral palsy (CP) in infancy. He had difficulty sucking and swallowing shortly after birth and failed to meet motor milestones on time, but his cognitive skills were normal. He was educated in a regular classroom with special educational support but often missed school due to illness and frequent doctor visits for his CP. He has never walked, but he can sit in a wheelchair, and his language is average. He recently graduated from high school but does not have a job. He would like to work in graphic design but lacks eye-hand coordination because of cortical visual impairment, and his fine motor skills are below average. Scott has few friends, mostly because he cannot organize or carry out meeting other people without assistance. The friends he has are similarly impaired and have the same barriers. He is dependent on his aging parents for all activities of daily living. Their income is below the poverty line, and they have their own health problems. Throughout infancy and childhood, Scott attended a specialty clinic at a large pediatric hospital for children with CP staffed by a team of physical and occupational therapists, developmental pediatricians, a pediatric physiatrist who administers Botox injections, a team of pediatric neurosurgeons and nurse practitioners who manage his baclofen pump, a pediatric orthopedic surgeon for his dislocated hips and contractures, a pediatric ophthalmologist, a pediatric anesthesiologist and pain specialist, social workers, and a special team of hospitalists for the medically complex to care for him when he requires admission to the hospital. Scott’s extensive medical records and team of specialists are readily available to help care for him until he turns 23 years, the age at which his children’s hospital stops seeing patients. Unfortunately, Scott is 22 years. All of the specialists who have cared for him from birth will soon no longer be available. On the eve of graduation from his state-of-the-art pediatric hospital, Scott’s physicians are very concerned about his future. He will likely continue living with his parents who are dependent on the Social Security benefits that come to them for Scott’s care. For financial reasons, they are not motivated to find an alternative living situation for him. Scott’s mother is worried about his health because he has worsening chronic hip pain, but, right now, she is more preoccupied with her own health concerns. Despite repeated discussions about transitioning to adult providers in the community, his family has made no effort to meet a new provider. In contemplating the future and in a state of relative isolation, Scott wonders if he will die young or suffer an adult life of pain. As a teen he felt invincible, but now, on the eve of his 23rd birthday, he is aching more and is less able to sit in his wheelchair. Finally, one day, he summons the courage to ask what he has always wanted to ask of his long-time physician. “What will my life be like? How long will I live?” The problems Scott faces are common. Transitioning to adult care providers is complicated and daunting. Concerns about the transition plague patients, parents, and professionals involved in the care of children and young adults with CP. What is the prognosis for a young person like Scott teetering on the precipice of adulthood? No professional can precisely answer this question for every individual with CP because each patient is unique with his or her own type and severity of CP, set of personality strengths and weaknesses, talents, and temperament. Comorbidities like intellectual disability (ID), communication impairment, presence of seizures, and behavioral disorders certainly play an important role in prognosis as well. Each person presents with their own family and that family’s attitude, belief system, financial situation, intellectual capability, and priorities. In addition, environmental factors like the availability of adult-oriented providers, local programs, state policies, and local resources can significantly impact outcomes. The goal of this article is to inform physicians and other providers about the challenges young adults with CP face when transitioning to adulthood to help them understand the issues concerning future needs and prognoses. The goal is to help health care providers to ease this transition, to encourage providers caring for these individuals to start planning early for this challenging process, and to advocate on a policy level.

Cerebral palsy grown up.

This study was designed to investigate the effects of transient neurologic signs evident in infancy on motor outcomes in 41/2-year-old children born biologically at risk. Children who appeared neurologically normal at each of the 4-month, 12-month, and 24-month visits in the Neonatal Intensive Care Unit Follow-Up Clinic were assigned to the neurologically normal (NN) group (n = 42). Children who appeared to have neuromotor abnormalities at either or both the 4-month and 12-month visits, and who were then rated as “normal” at the 24-month visit, were assigned to the transient neurological signs (TNS) group (n = 19). The groups were compared on motor and cognitive measures at the 41/2-year clinic visit. No significant differences between groups were found except on the measure of pencil prehension, in which the TNS group scored significantly lower (p < .01) than the NN group. A more thorough assessment of fine motor skills at the preschool level may be indicated when following the neurodevelopmental course ...

Forrest C. Bennett

Papers

Training residents in developmental pediatrics: results from a national replication.

Low Birth Weight Infants: Accomplishments, Risks, and Interventions

Early delay in motor development.

Cerebral palsy grown up.

Transient Neurologic Signs in Infancy and Motor Outcomes at 4 1/2 Years in Children Born Biologically at Risk.