motor function of infants with athetoid cerebral palsy

8
MOTGR FUNCTION OF INFANTS WITH ATHETOID CEREBRAL PALSY KetlJI ~‘okocf11 Saroslir Shrtnabukitro Mariko Ii‘odutna K a x o liodatria Akrhiko Hosoe Athetoid cerebral palsy has been shown to be caused by damage to the basal ganglia, mainly due to perinatal asphyxia or severe jaundice (Carpenter 1950; Polani 1959; Ingram 1964; Kyllerman et al. 1982; Foley 1983, 1992; Yokochi er a/. 1991~). Characteristic symptoms in childhood are involuntary movements, impairment of postural stability, oromotor dysfunction, and (in rare cases) mental problems (Carpenter 1950, Koven and Lamm 1954, Polani 1959, Twitchell 1959, Ingram 1964, Lesny 1968, Bobath and Bobath 1975, Kyllerman et al. 1982, Foley 1983). During infancy there may be generalized hypotonia, poor spontaneous move- ments, oromotor problems when feeding, continuous head-turning to one side, persisting primitive reflexes such as the Galant and Moro reflexes and occasional estensor spasms, with discrete in- voluntary movements developing later (Koven and Lamm 1954, Polani 1959, Ingram 1964, Lesny 1968, Bobath and Bobath 1975). Motor symptoms that predict severity of the later motor disability have not been resolved fully in athetoid infants. We examined motor function in infancy and correlated it with later motor disability in children with athetoid cerebral palsy. Materials and methods Video-recordings of 35 children with athetoid cerebral palsy (24 males, I1 females) were analysed retrospectively. The children were selected from outpatients attending the National Rehabilitation Centre for Disabled Children from 1981 to 1988, the Kagawa Rehabilitation Centre from 1980 to 1983 and Seirei-Mikatabara General Hospital from 1984 to 1988 for problems in motor development; all were less than one year of age. Videotape recordings were obtained for all infants visiting the three centres and we studied the recordings of children who were followed to more than three years of age and who developed athetoid cerebral palsy. Table I shows the perinatal data of the children. Athetoid cerebral palsy was diagnosed if there were no pyramidal signs, and where there were uncontrolled, in- of varying degrees of tension (Minear c c)\ I m 0 m 1c. r-, ‘? m c\ - - - 4 . voluntary and inco-ordinated movements $ 1956). 2 : 4 < The severity of the children’s gross motor disability was ranked according to that at three years of age, corrected for preterm birth. 11 children classed as ‘mild’ could walk without support; 11 children classed as ‘moderate’ could not s 2 s 8 4 _I - . . * < C .. - . walk, but could sit without support, while 13 children in the ‘severe’ category could None had undergone any surgical 4 2 9, - 4 The severity of the children’s fine 909 . tc not sit without support. All had had physical therapy from the first year of life. procedure.

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Page 1: MOTOR FUNCTION OF INFANTS WITH ATHETOID CEREBRAL PALSY

MOTGR FUNCTION OF INFANTS WITH ATHETOID CEREBRAL PALSY

KetlJI ~‘okocf11 Saroslir Shrtnabukitro Mariko Ii‘odutna K a x o liodatria Akrhiko Hosoe

Athetoid cerebral palsy has been shown to be caused by damage to the basal ganglia, mainly due to perinatal asphyxia or severe jaundice (Carpenter 1950; Polani 1959; Ingram 1964; Kyllerman et al. 1982; Foley 1983, 1992; Yokochi er a/. 1991~). Characteristic symptoms in childhood are involuntary movements, impairment of postural stability, oromotor dysfunction, and (in rare cases) mental problems (Carpenter 1950, Koven and Lamm 1954, Polani 1959, Twitchell 1959, Ingram 1964, Lesny 1968, Bobath and Bobath 1975, Kyllerman et al. 1982, Foley 1983). During infancy there may be generalized hypotonia, poor spontaneous move- ments, oromotor problems when feeding, continuous head-turning to one side, persisting primitive reflexes such as the Galant and Moro reflexes and occasional estensor spasms, with discrete in- voluntary movements developing later (Koven and Lamm 1954, Polani 1959, Ingram 1964, Lesny 1968, Bobath and Bobath 1975). Motor symptoms that predict severity of the later motor disability have not been resolved ful ly in athetoid infants. We examined motor function in infancy and correlated it with later motor disability in children with athetoid cerebral palsy.

Materials and methods Video-recordings of 35 children with athetoid cerebral palsy (24 males, I 1

females) were analysed retrospectively. The children were selected from outpatients attending the National Rehabilitation Centre for Disabled Children from 1981 to 1988, the Kagawa Rehabilitation Centre from 1980 to 1983 and Seirei-Mikatabara General Hospital from 1984 to 1988 for problems in motor development; all were less than one year of age. Videotape recordings were obtained for all infants visiting the three centres and we studied the recordings of children who were followed to more than three years of age and who developed athetoid cerebral palsy. Table I shows the perinatal data of the children.

Athetoid cerebral palsy was diagnosed i f there were no pyramidal signs, and where there were uncontrolled, in-

of varying degrees of tension (Minear

c c)\ I

m 0 m

1c. r-,

‘? m c\

-

- - 4 .

voluntary and inco-ordinated movements $

1956). 2 :4 <

The severity of the children’s gross motor disability was ranked according to that at three years of age, corrected for preterm birth. 11 children classed as ‘mild’ could walk without support; 1 1 children classed as ‘moderate’ could not

s 2 s

8 4

_I - . . *

< C .. - . walk, but could sit without support, while

13 children in the ‘severe’ category could

None had undergone any surgical

4

2 9, - 4

The severity of the children’s fine 909

. tc not sit without support. All had had

physical therapy from the first year of life. procedure.

Page 2: MOTOR FUNCTION OF INFANTS WITH ATHETOID CEREBRAL PALSY

.’ . a2

L 0

TABLE 1 Perinatal data of the subjects (N=35).

~~

Sex Male 24 Feniale I 1

37-42 30 32-26 5

z ’500 30 2000-2499 4 1500-1999 I

Asphysia 19 Jaundice 9 Unknown - 3

Cesiarional age (wks)

Birthweight ( g )

Cause of aiheroid cerebral palsy in 30 ierms infants (gesiaiional age 2 37 t v k o

TABLE I 1 Gross and fine motor disability and mental dewlopment of the subjects

Gross inoror Fine motor disabilily Total disbili [y

Severe Aloderare Mild

Severe S J 1 13 Moderate 0 6 5 I 1 Mild 0 0 I I I 1 Total 8 10 17 35

motor disability was graded according to their upper-extremity function at three years of age (Table 11). 17 children in the ‘mild’ category could grasp a peg (about Icm in diameter and about 5cm in length) and put it in a hole while sitting with or without support or lying down on their side. 10 children classed as ‘moderate’ could grasp a peg but could not put it in a hole. Eight children classed as ‘severe’ could not grasp a peg. The grade of severity of the children’s fine motor disability correlated significantly with their gross motor disability @<0*001, 1’ test).

The mental developmental ages of the subjects were assessed by these items for which locomotive, fine motor and articulatory disability had little or no influence at three years of age. 12 children had mental ages of at least t w o years, and the other 23 had mental ages of more than one year. Four children had epilepsy. 910

We studied the recordings of the childrens’ motor functions that had been made between five and eight (mean 6-7 , SD 1 . 1 ) months of age, corrected for gestational age. Various postures, upper- and lower-extremity movements, and primitive reflexes had been videotaped for five to 10 minutes. In the resting supine position, recordings had been made of the children’s spontaneous movements of the upper and lower extremities and trunk, neck rotation foilowing an object such as a rattle in front of their faces, and reactive movements of the upper extremities to an object in front of them. Recordings had also been made of postures in the prone position, in ventral suspension, and pulling up from supine. Among primary reflexes, there were recordings of the asymmetric tonic neck reflex (ATNR) and the Moro and Galant reflexes.

The nature of the knee jerks, and presence or absence of ankle clonus, were checked from the medical records of the subjects. The video recordings allowed us to assess each infant’s resting supine posture, postural change with active neck rotation, upper- and lower-extremity movements in the supine position, prone position, ventrally suspended posture, posture during pulling up from supine, and abnormal facial movement. The postures and movements were described, and the relationship between their patterns and the grade of gross and fine motor disability at three years of age was examined.

ATNR was judged to be present when the elbow was extended on the face side and flexed on the occipital side for longer than three seconds, after active or passive rotation of the neck; movements of the elbow less than 20” and movements of the lower extremities were ignored. The moro reflex was judged to be present when the arms were extended and abducted and the fingers extended after sudden drop of the head. The Galant reflex was judged to be present when the back along the paravertebral area was stroked by the examiner’s finger and the trunk curved, with the concavity on the stimulated side. Each infant was examined for these three reflexes, and the finding was contrasted with the grade of gross and fine motor disability.

Page 3: MOTOR FUNCTION OF INFANTS WITH ATHETOID CEREBRAL PALSY

As a control, the motor functions of 30 infants with spastic diplegia were retrospectively examined with the video- recordings between five and eight months of age (6.Sf 1 .3 months), corrected for preterm birth; they were not significantly different from the ages at which the athetoid infants were examined. Spastic diplegia was diagnosed i f there was bilateral hypertonic involvement of the lower extremities, with lesser involvement of the upper extremities and absence of involuntary movements, and was confirmed at one year of age or more. Two children's birthweights were over 2500g, one was 3OOOg to 3500g, 10 were 15009 to 1999g, 14 were lOOOg to 1499, and three were < IOOOg. Gestational ages were L 37 weeks for two children; for the other 28 they were 5 3 6 weeks. At three years of corrected age, 10 children were able to walk without support, 10 walked with support, and 10 could not walk even with support; all children could grasp a peg and put i t in a hole wi th each hand. The children's intelligence quotients were 50 or over. The motor functions of the diplegic infants were analysed in the same way as those of the athetoid infants.

Results During the examination at five to eight months of age, three infants could roll over, and six others could stay lying on their sides. None could sit without support or creep. One infant had good head-control when sitting supported.

All infants turned their heads to one side most of the time, and many adopted an opisthotonic posture. Most athetoid infants lay asymmetrically. No athetoid infant showed tonic neck reflex, but three diplegic infants had a sustained response. All athetoid infants looked at a small object in front of their eyes with a fixed gaze, but some of them could not follow it with a full range from one side to the other.

The asymmetric posture in the infants was ranked as follows, and the relationship between each pattern and the grade of later disability is shown in Table 111. (A) The infant's head always turned to one side, and the infant could not turn the neck fully to the other side while following an object; (B) the infant could

turn the neck fully to the other side, but there was truncal rotation while following an object; the shoulders also moved. (c) the infant could turn the neck fully to the other side without truncal rotation while following an object; the shoulders did not move.

Difficulty in taking a symmetric posture was significantly correlated with the severity of later gross and fine motor disability in the athetoid children; this difficulty was not seen in che diplegic infants.

The athetoid infants could not move their arms forward fu l ly in the supine position, and none could grasp a small object in front of them. The upper- extremity movements at rest and when an object (such as a rattle) was presented to them were grouped into three patterns as follows, and the results are shown in Table 111. They were classed according to whether they could keep at least one arm in a position for at least three seconds. (A) The infant could not hold the hand medially from the lateral border of the trunk. The shoulder adducted horizontally across the lateral border of the trunk with continuous movements, such as rotation or to-and-fro; (B) the infan- :Id hold the hand medially from the lateral border of the trunk; (c) the infant could hold the elbow while abducting the shoulder horizontally less than 45" and flexing more than 30".

Difficulty in extending the arm forward was significantly correlated with the severity of later gross and fine motor disability in the athetoid children: this difficulty was not seen in the diplegic infants.

Most infants could not elevate their legs in the supine position. From spontaneous movements of the lower extremities, we analysed movements of the hips and knees of more than about 10" without rotation of the trunk (Yokochi ef al. 1991b). The movements of the ankles only were ignored. Continuous movement of the hips and/or knees without a pause of more than about one second was regarded as one movement. The spontaneous leg movements were grouped into three patterns as follows, and the results are shown in Table 111. (A) The infants had simultaneous flexion and extension of the

. > -.

911

Page 4: MOTOR FUNCTION OF INFANTS WITH ATHETOID CEREBRAL PALSY

TABLE 111 i

... 4 Motor behavior and primithe reflexes - - 5

Fine rnoior disabiliiy InJanis Injanis 2 .o Will1 with

Severe Moderare Mild Severe Aloderaie Mild aiheioid spusric ( N = 13) (N= I I ) (if'= I I ) ( N = 8 / ( N = 10) ( N = 17) CP diplegici ., (N = 3-71 (N = 301

I

Gross tnoior disabiliiy

h

.- .=. '2

I Posiirres and sponlaneorrs t t ~ o i ~ c ~ ~ ~ e n i s ( I ) Asymmetric posture

A 3 0 0 B 10 8 1 C 0 3 10

*** ( 2 ) Upper-elrremity movements

A 9 5 1 B 2 4 2 C 2 - 8

I-T- ' ?

* * (3) Spontancous leg movements

A I3 6 I B 0 5 7 C 0 0 3

-'+A J I ** , * - ***

(4) Prone posture A 7 I 0 B 6 9 7 C 0 I

L- 7- * ***

(5) Ventral suspension A 7 3 I B 5 7 4 C I

(6) Traction response A I3 I I 7 B 0 0 4 C 0 0

* I I . Prirniir ve rejlcxes

13 7 3 ATNR ( + ) L_r_J

*** Galant ( + ) 13 10 9

hforo ( + ) I2 I I 9

3 0 0 5 9 5 0 I I2

***: 6 8 I I I 6 I I 10

1-7- /-,_*LJ **

8 8 4 0 2 I0

0 3

7- * * *

5 2 I 3 7 I2

1 4

I I, * * 3 4 4 4 5 7 1 I 6

8 .I 0 13 0 0 4 0 0 0

* * 8 9 15

7 10 15

3 0 19 0

15 0 8 0

12 30 1-J 1-

* * *

20 27 12 3

3 0 1- 1 - 1

I I 0 16 17 8 13 - ***

31 6 4 IS 0 6

T-J L.-

* **

23 S - **

32 I2

32 I4 - *;*-

*** r . - . - - - ..-

*p<O.OS, **p<0.01, ***p<0.001 (,$ or Fisher exact test). ( I ) A: unable to follow to other side. €3: able to follow to other side with iruncal rotation. C : able to follow to other side without truncal rotation. (2) A: hand not held medially from lateral border of trunk. B: intermediate between A and C. C: shoulder abducted horizontally less than 45" and flexed more than 30". (3) A: simultaneous flrsion and extension of hips and knees only. B: isolated hip movements ( + ). C : hip flexion combined with knee extension (+). (4) A: unable to keep head up. B: able 10 keep head up, unable to support weight on elbows. C : able to support weight on elbows. . ( 5 ) A: unable to extend trunk and neck. B: able to extend trunk and neck, almost parallel to a horizontal plane. C: able to extend neck. (6) A: unable to flex neck. B: able to flex neck to longitudinal axis of trunk. C : able to flex neck beyond longitudinal axis of trunk. 912

Page 5: MOTOR FUNCTION OF INFANTS WITH ATHETOID CEREBRAL PALSY

hips and knees only. When the hips were flexed from a position -of extension, the knees were flexed simultaneously. When the hips were extended from a position of flexion, the knees were extended simultaneously: (8) the infant had isolated movement of the hips with the movement of A . The knees kept a fixed position, either llesed or extended, and the hips moved in any direction. When the leg appeared to move only because of truncal movements, the hips werc not classed as havins moved: (c) the infant had hip flexion combined with knee extension. The hips were flexed and the knees were extended simultaneously. When the leg apparently moved because of truncal movements, the hips and knees were not classed as having moved.

No infants exhibited the isolated knee movement. Difficulty in making isolated movements of the hips or knees was significantly correlated with the severity of later gross and fine motor disability in the atheroid children; this difficulty was more prominently seen in the diplegic infants.

I n the prone position, most infants could not support their weight equally on both elbows, nor hold their heads up symmetrically. By evaluating the positions of the infants' heads and arms, the prone postures were grouped into three patterns, and the results are shown in Table 111. (A) the infant could not keep the head above the floor. When the head was raised for less than about three seconds, i t was not classed as being kept up: (B) the infant could keep the head above the floor and support the weight on the arms. Some of the infants in this category supported their weight on one arm with one elbow flexed and the other extended. In the other, the shoulders were too flexed, extended, or abducted horizontally; (c) the infant could support the weight on the elbows. when the shoulders were abducted. horizontally less than 45" and flexed from 30" to 120".

Difficulty in extending the neck and supporting the weight on the arms was significally correlated with the severity of later gross and fine motor disability in the athetoid children; this difficulty was more prominent in the athetoid infants than in the diplegic infants.

'

Most infants could not extend 'the neck and t r u n k when held in ventral suspension. In this position, extension of the neck and trunk was grouped into three patterns as follows, and the results are shown in Table 111. ( A ) the infant could not extend the t r u n k , which looked like an inverted LI. The longitudinal axis of the head was at an angle of more than 20" to a horizontal plane; (B) the infant could extend the t r u n k and neck: the axis was at an angle of between -20" and 30' to a horizontal plane; (c) the infant could estend the neck: the axis was upward, at an angle of more than 30" to a horizontal plane.

Difficulty in extending the neck and t r u n k in ventral suspension was significantly correlated with the severity of later gross motor disability in the athetoid children; this difficulty was more prominent in the athetoid infants th.an in the diplegic infants.

Most infants could not flex the neck when they were pulled from the supine position. At this traction response, neck extension was groupd into three patterns (as follows) when the longitudinal axis of the trunk was 45" to the floor. The results are shown in Table I l l . (A) the infant could not tles the neck; its longitudinal asis was more than 30" below that of the trunk; (B) the infant could fles the neck between A and c; (c) the infant could fles the neck; its longitudinal axis was more than 10" above that of the trunk.

Difficulty in flexing the neck in the traction response correlated significantly with the severity of later gross motor disability in the athetoid children; this difficulty was more prominently seen in the athetoid infants than in the diplegic infants.

All infants opened the mouth asymmetrically or escessively twice or more during the videotape recordings, this was associated with active movement of the neck, arm or trunk, or with postural change. Mouth opening occurred in eight diplegic infants, but was seen significantly more frequently in the athetoid infants @<0.001, xz test).

Exaggerated knee jerks and sustained ankle clonus were not found in athetoid infants, but were present in four diplegic infants. Table 111 shows three primitive

P, QI

Q'

E . h

h $ . z

913

Page 6: MOTOR FUNCTION OF INFANTS WITH ATHETOID CEREBRAL PALSY

i

.-

L 0

i 0 0 L

- c

914

reflexes in the subjects: ATNR and the Moro and Galant reflexes. Most athetoid infants had Moro and Galant reflexes, and the athetoid infants with the severer motor disability had ATNR. These three reflexes were seen more frequently seen in the athetoid infants than in the diplegic ones.

Determination of the pattern for each item was made independently by two observers ( K . Y . , ~ I . K . ) , with 90 per cent agreement.

Discussion Infants with cerebral palsy have been known to show persistent primitive reflexes or a delay in their disappearance (Capute 1979). This study suggests that the delay in the disappearance of the ATNR, Moro and Galant reflexes is more conspicuous among at hetoid than spastic infants, as shown by Futagi et al. (1992). Although evaluating primitive reflexes can help in the diagnosis of athetoid cerebral palsy in infancy, other motor symptoms should be examined to differentiate athetoid cerebral palsy from other types, and to assess the severity of the athetoid motor disability.

Our study confirmed previous findings that athetoid infants had difficulty keeping a symmetric supine posture, waking isolated movements of the hips and knees, keeping their arms in forward extension, extending the neck and trunk in the prone position and ventral suspension, flexing the neck in the traction response, and supporting their weight on their arms (Koven and Lamm 1954, Polani 1959, Ingram 1964, Lesny 1968, Bobath and Bobath 1975).

Athetoid infants, uniike diplegic ones, find it hard to keep their neck and trunk in a symmetric position. This difficulty did not necessarily coincide with the presence of ATNR, because the asymmetric posture of all the diplegic infants with ATNR was in category C. The athetoid infants showed excessive extensor tone in neck and trunk muscles, often associated with opisthotonus. A small number of them showed adequate antigravity extension of the neck, classed as ventral suspension group C ; but many of the infants, when they were in the prone position or in ventral suspension, showed

limited antigravity extension of the neck and trunk. This extension was more deficient in the athetoid than in the diplegic infants.

Our previous study (Yokochi et a/. 1989) showed that athetoid children had difficulty supporting their weight on their upper extremities, especially on their elbows. This was also true for the infants in this study. Athetoid infants also found i t difficult to extend their arms in the supine position, where the weight was not supported on the arms, and-unlike diplegic infants-they sometimes had trouble with simultaneous flexion and horizontal adduction of the shoulder.

Isolated movements of the hips and knees were difficult in both groups of infants (Yokochi et 01. 19916), bur the infants with mild athetosis-unlike the diplegic children-had hip flexion combined with knee extension (c). Isolated knee movement was not seen even in the infants with mild athetosis, and seemed to be especially difficult in the at he t oid in fan t s .

The asymmetric or excessive mouth- opening is assumed to be an involuntary movement of the infantile period. I t was present in some diplegic infants who showed no involuntary movements at any site, including the mouth, later in childhood: so this mouth-opening shown at the infantile period may disappear later in diplegic patients.

Motor symptoms that are specific to athetoid infants include difficulty in keeping a symmetric supine posture, limited forward extension of the upper extremity, poor stability of the neck and trunk, and asymmetric or excessive opening of the mouth; therefore they are more useful for diagnosing athetoid cerebral palsy in infancy than the presence of ATNR, and the Galant and Moro reflexes. Further study is needed on the precise diagnosis of mild athetosis and to differentiate between pure athetosis and mixed athetosis with spasticity.

This study showed that the grade of difficulty that the athetoid children had in each posture and spontaneous movement reflected their later motor disability. Having difficulty in four of six postures and movements was correlated with both gross motor and fine motor

Page 7: MOTOR FUNCTION OF INFANTS WITH ATHETOID CEREBRAL PALSY

disability. This may be caused by the Seirei-hlikatabara General Hospital. Shizuoka. correlation between them in the subjects: our method of classing each posture and movement in one of these categories has proved to be valuable for predicting [he severity of the later motor disability.

ity::ii Sliin,ahu~uro, hl.D.; hfari);o Lodama, M.D.: Kazuo Kodama, X1.D.; Department of Pediatrics. National Rehabilitation Center for Disabled Children. Tokyo, Japan. Akihiko Hosoe. M.D.. Denartmcnr of Pacdiarrics, Kagatra Rehabilitarion Centre, liagawa. Japan

.Jcwpitsd .lor p i rb l i~~l i ior i 1 1 ih Fehrirur! 1993.

.-I irrhors' .-lppoinrt~ienrs 'Kenji Yokochi, M.D., Director of Olizora-no-iye Hospital, and Department o f Pediatric Neurology.

* Corre.cponden ct' 10 .firs/ air r lr or a t 0 h zo r a - n o - i ye Hospiial, 7.148 Nakaga~a, Hosoe, ~nasa, Shizuoka 471-13, Japan.

su hl M A K Y The motor function of 35 children witti athetoid cercbral palsy \\as examined retrospectively using videotape recordinss made at five to eight months o f age. h,lany infants showed asymmetric tonic neck, h,loro and Galant rcflexcs. klovements shown to be difficult included: keeping a symnietric supine posture. isolated niovemcnts o f the hips and knees, forward estcnsion o f the upper extremity. estension of neck and trunk in the prone position and in ventral suspension, flexion of the neck in the traction response. and weight support by the upper extremities. Asymmetric or sscctssive opening of the niouth was present in all infants. The grade ol' difficulty for cach posture and inwement might retlcct subsequent motor disability at three years of age.

RESUME Foticrion riioirice che; les nourrissons prcsertratir uiie . forme orherosicpie d ' I iVC La fonction rnotrice de 3 5 enfanrs presentan1 une lh lC de forme athetosique fur ivaluee r~itrospcctiwment par enregistrtments vidko effectues entre cinq et huit mois. De nombrctus nourissons priscntaicnt un riflcse asyniitrique du cou, dcs reflescs de Moro ct de Galant. Les niouvenients qui se revelaienr difficiles etaient: le rnaintien d'une posture symetriquc &endue sur le dos, de5 mouvemcnts isolCs dcs hanches et des genouu, une estension en avant des extremites superieures, tine estension du cou et du tronc en posture stir le vcntre ou en suspension ventrale, la flexion du cou en reponsc au tire assis, et le support du poids par Ics bras. L'ouverture de la bouche etait asynietriquc ou exagertk cliez totis les nourrissons. Le niveau dc difficult; pour obtcnir une posture ou k i n mouvement peut rellkter unc incapaciti. motrice ulthieure, apparaissant i I'age de irois ans.

ZUS.4M MENFASSUNG Mororischc Fiinkrion bei Kitiderti t i i i i arheroiisctier Cerebrulparese Bei 35 Kindern mit arhetotischer Cerebralparese wurde die motorkche Funktion retrospektiv anhand von Vid .oaufzeichnungen, die im Alter von lunf bis acht h,lonatcn gemacht worden \varen, untersucht. Vide Kinder hntten asymrnetrisch tonische Hals-, Moro- und Galanr Reflese. Schwierige Bewegungen warcn: eine syrnmetrische Riickenlage zu halten, isolicrte Bewegungen von Huf t - und Kniegelenkcn, Armstreckung nach vorn, Hals- und Rumpfstreckung in Bauch- und Bauchhangelage, Beugung des Halses bei der Dehnungsreaktion und Halten des Gewichtes durch die obere Extremitht. Asymmetrisches oder starkcs Offnen des Mundes fand sich bei allen Kindern. Der Schwierigkeitsgrad fur jede Haltung und Bewegung ktinnte nachfolgende motorischc Storungen im Alter von drei Jahren widerspiegeln.

RESUMEN Frincion t?io[ora de laclarites con paralisis cerebral aletoidea Se esamino la funcion motora de 3 5 niilos con paralisis cerebral atetoidea de forma retrospectiva, utilizando registros con video a la edad de cinco a ocho meses. Muchos niAos mostraron unos reflejos t6nico del cuello, de Moro y de Calanr asimtitricos. Los movirnientos que se vieron quc estaban dificultados fueron: el mantcnirniento de una postura sirnetrica en supino, movimienros aislados de caderas y rodillas. estension hacia adelante de la extremidad superior, estensibn de cabeza y tronco en posicion prona y en suspension ventral, flexion del cuello en la respuesta a la traccion, y soporte del peso con las estremidades superiores. En todos 10s casos habia una apertura de la boca excesiva o asimetrica. El grado de dificultad para cada postura y cada movimiento puede reflejar la subsiguiente discapacidad motora a 10s tres aiios de edad.

,

Rejereiiccs ganglia. Review of the literature and study of Bobarh. B., Bobath. K . (1975) Moior Developrnenr forty-two cases.' Archives of Neurology and

Psychiatry, 63, 875-901. Foley. J. (1983) 'The ath,etoid syndrome. A review

Capute. A. J . (1979) 'Identifying cerebral palsy in of a personal series. Joirrnul 01 Neirro/og.v,

- (1992) 'Dyskinetic and dystonic cerebral palsy Carpenter, M. B. (1950) 'Arhetosis and the basal

in [he DiJfereni Types oJCerebra1 Palsy. London: Heinemann Medical.

infancy through study of primitive-reflex Neurosurgery and Psychiorry, 46, 289-298. profiles.' Pediurric Annals, 8, 589-595.

and birth.' Acta faediairica, 81, 57-60.

. 5 2

915

Page 8: MOTOR FUNCTION OF INFANTS WITH ATHETOID CEREBRAL PALSY

i

2-

h

,. * - n a

Futagi, Y . , Tagawa, T., Otani, K . (1992) ‘Primitive reflex profiles in in fanrs: differences based on categories of neurological abnormality. Bruin and Developitrenr, 14, 394-29s.

Ingram, T. T . S. (1964) Paediarric .-lspecrs o/ Cerebral fu1s.v. London: E. & S. Livingstone.

Koven, L. J . , Larnrn, S. S. (1954) ‘The atheroid syndrome in cerebral palsy. Part I I : Clinical aspects.’ Pedioirics. 14, ISI-192.

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